my B DEPARTMENT OF FINANCE & ADMINISTRATION Office of Personnel Management Proof of Prior Service P.Ot Rea eece Tian Ho O QAlo-Oh Prior Service Employment Dates [eras bee ame eave Aeatl Bate Faromareé Raprasa Ose GAlo- O Prior Service Leave Balances Tian ave PR ex Lewe Wis maey Retirement Systath inseue hevonent& COPER Contributory = C]PERS. Authorization Tanase NY C Arproved C] Bisapprover * “Garnpacseiany Leovb (a na) TOTAL PRORLEAVE Gia hone) Cref. ‘ate (MiB \Ort0-Ch0 Taiegere | PG evah Fax tanowTRA HUMAN RESOURCES Fax:5016852174 Oct 25 2006 13:29 F.02 DEPARTMENT OF FINANCE & ADMINISTRATION Office of Personnel Management 4] Proof of Prior Service Prior Service Employment Dates | Siarrresae feu aie ae aa ea —| | O-Hlo-O 1-1 —! will Service Leave Balances ~ ‘Aroual Leave (Ha Tine, | ‘Sik Leave (Hrs ina) Compensatary Leave (Hie. Adie) TOTAL PRIOR LEAVE (rraitdins) Retirement System ave tranar Scorn whic enor pated we pre tte ance CIPER Contributory PERS Non-Contributory TRS Cmaa-cref, Authorization One Taba Cl Approves 11 Diseopreved rn —=—— L \O-BANo | FAKE Au0% BaanArkansas Department of Health ma and Human Services > one . tere OFA 10/4, QUEST FOR PERSONNEL ACTION, SECTION 10-%.0@ Division: _Office of Chief Counsel 9, Aon Insticution’County Ortice: OR Central OMtce: ‘County employee works in: _Pulask SECTION 1 Employee Name: Rudledge c Tas wi SECTION IIL eve brit the tyne of Persuone! Action foe taken on the aove named enmployee, al the reason for the aetion, Brewttre Denice OPrromotion — OUCLPPromotion []TrisLevel Promotion []Demotion [Transfer LD Terraination Reason (DCO Only) Bouter a Cnr neu Jhon atte ae Ena mE | 5 RIVES. ‘Employee transferring 10 enother Arkensas State Ageney — [] Yes, specify no SECTION LV Firm, 220% SSuOB, AOFe| 24; ‘The following information ianceded in order to process this request 1 AASIS Posen Member an Pion Th BERNOH (At epoer 2u3ie) 2. Clas Code aed Grade R036 “Time Administrator's Name Tina Lee /3¥ 3. Bh superior C] NomeSuperviae Fodan 3 4, Ofie Phone Numer Jay Resancon/ 682-1994 PERSONNEL AREA HSS2 - mi Weshy Pay Pera Hour’ Planned Warkng Time §) (Fvample: HS29) 6. Mowry Rote 20.4927 C)LMR C1 GWO (Arash Form 080.081 & Justification) SECTION V The documents checked below sre provided as necessary for the described personzel action: Bi Completed Apoliation Form, Resume, ete. [1] Resignation/Tersination Later tinclude hump sum payraien: hours in Setion {1} BB Other Retr co Section IT, Bo Me ogc NE Be Ot Supervisor Division Director/Designee Requesi Tastinnional Personnel Officer (Papplicable) DAWOHR Personnel Processing Omnicer DHHS-1161 (R 08-05)