EMPLOYEE PROFILE MANAGEMENT Name Prefix: (Dr., Mrs., Mr., Ms.) Home Phone: First Name: Mobile Phone: Middle Name: WVDE Work Phone: Last Name: Work Extension: Birth Date: Name Suffix: (II, Jr., Sr., etc.) Social Security #: Sex: Race: Home Address: Street City State Zip County Mail Address: Street City State Zip County EDUCATION LEVEL/YEARS OF EDUCATION EXPERIENCE Educational Level: County Salary Schedule: Years of Ed. Experience: Days of Employment: *National Board Certified: Full-Time Permanent: Temporary: National Board Expiration Date: PT Daily/Hourly Rate: Name of College Attended: Retirement (County Only) TYPE OF ACTION NOTE: Fill out accounting information below – New Employment Salary Adjustment Reduction in Force Leave of Absence Reclassification Salary Advancement Return to Duty Medical With Pay Resignation Suspension/Dismissal Medical Without Pay Retirement Termination Personal Transfer Parental/Family Leave Other Last Day Worked: NEW ACCOUNT INFORMATION Position Position No.: Effective Date: Replacing: Justification: Division: Home Unit: Office/OIEP Name: No. Interviewed: Work Site (Ex.: Capitol): Room No.: Supervisor ID: Supervisor Name: NEW ACCOUNT INFORMATION CONTINUED Fund Approp. Program FTE PPC Base Salary Annual Increment Sub Total Salary Unit
EMPLOYEE PROFILE MANAGEMENT Name Prefix: (Dr., Mrs., Mr., Ms.) Home Phone: First Name: Mobile Phone: Middle Name: WVDE Work Phone: Last Name: Work Extension: Name Suffix: (II, Jr., Sr., etc.) Birth Date: Social Security #: Sex: Race: Home Address: Street City State Zip County Mail Address: Street City State Zip County EDUCATION LEVEL/YEARS OF EDUCATION EXPERIENCE Educational Level: County Salary Schedule: Years of Ed. Experience: Days of Employment: *National Board Certified: Full-Time Permanent: Temporary: National Board Expiration Date: PT Daily/Hourly Rate: Name of College Attended: Retirement (County Only) TYPE OF ACTION – NOTE: Fill out accounting information below New Employment Reclassification Resignation Retirement Transfer Salary Adjustment Salary Advancement Reduction in Force Return to Duty Suspension/Dismissal Termination Leave of Absence Medical With Pay Medical Without Pay Personal Parental/Family Leave Other Last Day Worked: NEW ACCOUNT INFORMATION Position Position No.: Effective Date: Replacing: Justification: Division: Home Unit: Office/OIEP Name: No. Interviewed: Work Site (Ex.: Capitol): Room No.: Supervisor ID: Supervisor Name: NEW ACCOUNT INFORMATION CONTINUED Fund Approp. Unit Program FTE PPC Base Salary Annual Increment Sub Total Salary
WV11%20wvOasis%20revised%209%2023%202015.docx