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Scotland coUntY ScHoolS EMPloYEE actIon FoRM Employee Status:

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Scotland coUntY ScHoolS
EMPloYEE actIon FoRM
(03/2<((,1)250$7,21
Employee Status: ☐Full Time Permanent ☐ Full Time Temporary ☐ Part Time Permanent Part Time Temporary
Months Employed: ☐12 ☐ 11 1
 Other _________
Employee
Name:
Location:
Assignment:BBBBBBBBBB*UDGHBBBBB6XEMHFWBBBBBBBBBBBBB
Certified ☐Classified 5HWLULQJ5HVLJQLQJ7HUPLQDWHG7HPSRUDU\3RVLWLRQ7HPSRUDU\&RQWUDFW(QGHG

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Replacing:
Ending
Date:
Principal/Supervisor+5SignatuUH
Date
5()(5(1&(6:
Name: __________________________ Position: _____________________________ Phone #:______________
Name: __________________________ Position: _____________________________ Phone #:______________
(03/2<((75$16)(5PLMPLOYEE TRANSFER:EMPLOYEE TRANSFER:
From: ___________________________ To: ____________________________
Replacing:
Classified☐ Certified ☐
HR USE onlY:
+586(21/<

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Criminal
Background
Check
completed?
☐
Yes
☐
No Date
Completed:
Drug
Screening
Completed?
☐
Yes
☐
No
Date
Received:
Salary Grade:_________ Step:_______
Is Employee )XOO\&HUWLILHG? ___Yes ___No
(PSOR\HHStatus: %HJLQQLQJ7HDFKHUBBBBB%HJLQQLQJ7HDFKHUBBBBB%HJLQQLQJ7HDFKHUBBBBB
(
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/DVW)RXURI66BBBBBBBBBBBRU(PSOR\HH,'BBBBBBBBBBBB
Employee Start Date:
Comments: ________________________________________________________________________________________________________________________________
Health Benefits:YesBBBBB NoBBBBB

_______________________________________
_____________________________________________BBBBBBB
Date
______________________________
([HFXWLYH'LUHFWRU$GPLQ$VVW of Human Resources Signature
Residency 1 _____ Residency 2 _____ Residency 3 _____
Emergency Permit _____ Permit To Teach _____
HR Dept
Other
: ____________________________ (Reason)
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Scotland coUntY ScHoolS EMPloYEE actIon FoRM Employee Status:

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Completed 24 September 2020

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