Arizona State Personnel System
NEW EMPLOYEE MOVING/TRANSPORTATION COSTS AGREEMENT
NOTE: Approval of the Arizona Department of Administration Director is required before this
agreement can be executed. Please refer to the Ariz
ona State Personnel System (ASPS)
Statewide Policy, Transportation or Moving Expense Reimbursement for New Employees.
Agency Name
Position Title
Position Number
Name of New Hire
This agreement between the new hire and agency listed above covers moving and other transportation
expenses reimbursed in connection with the employee moving from outside Arizona to this state for employment
in the Arizona State Personnel System (ASPS). In accordance with the ASPS Statewide Policy,
Transportation or Moving Expense Reimbursement for New Employees, I agree that if I leave my position
within 12 months of my official employment start date I will repay the agency the amount I received as
reimbursement on a month-for-month prorated basis (e.g., if I remained in the position for five months, I would
owe the state for 7/12ths of the amount I received).
In addition, I certify that I shall not and have not received reimbursement for moving or transportation costs from
any other source; and I have not received reimbursement from the State of Arizona for moving or
transportation expenses within the past five years.
Agency Head
Signature
Date
ASPS/HRD-FA3.04 09/19
Total Amount of Reimbursement
Date
New Employee
Signature
When both signatures are obtained, provide a copy of this agreement to the new employee. The agency head
shall maintain the original.
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