Employee Data Sheet - Full Version | Kansas Department of Administration

Last Name:

First Name:

Email of Person Submitting Request:

*

Telephone Number of Person Submitting Request:

Action:

Add

Update

Correct

Delete

Please include any information below that will help process this request.:

Empl. ID:

Dept. ID:

Dept. Name:

Employee Record Number:

Position Number:

Effective Date:

Prefix:

Mr.

Mrs.

Miss

Ms.

Dr.

Name (Last, First, MI):

Birthdate:

Date of Death:

Effective Date:

Gender:

Female

Male

Unknown

Highest Education Level:

Marital Status:

Marital Status Date:

Address Type:

Address 1:

Address 2:

City:

State:

County:

Country:

Zip Code:

Ethnic Group:

Date Entitled to Medicare:

Military Status:

Citizenship - Proof 1:

Citizenship - Proof 2:

Eligible to work in US?:

Yes

No

Effective Date:

Effective Date Sequence:

Action Code:

Reason Code:

Position Number:

Job Code (Defaults from Position Data):

Tax Loc.:

FICA Status:

Holiday Schedule:

Grade/Step:

Compensation Rate:

Employment Status:

Probation

Permanent

Trainee

Not Applicable

Probation End Date:

Schedule Effective Date:

Schedule ID:

Benefit Record Number:

Program Effective Date:

Annual Benefits Base Rate:

Bas Group ID:

Eligibility Field 1:

Eligibility Field 2:

Benefit Program:

Add Years:

Subtract Years:

Add Months:

Subtract Months:

Add Days:

Subtract Days:

Payable Time Start Date:

Effective Date:

Time Reporter Status:

Active

Inactive

Time Reporter Type:

Time Elasped Template:

Workgroup:

Taskgroup:

TCD Group:

(Interface Agencies Only)

Action:

Add

Update

Correct

Delete

Dept ID.:

Empl. ID.:

Empl. Name:

Empl. Rcd. Nbr.:

Review Effective Date:

Review Type:

Review Date From:

Review Date To:

Next Review Date:

Review Rating:

Reviewer ID:

Comments (Number of Feedback Sessions):

Dept. ID:

Empl. ID:

Empl. Rcd. Nbr.:

Empl. Name:

Select:

Increase

Decrease

Correct Balance:

Reason:

Select:

Increase

Decrease

Correct Balance:

Reason:

Select:

Increase

Decrease

Correct Balance:

Reason:

Select:

Increase

Decrease

Correct Balance:

Reason:

Select:

Increase

Decrease

Correct Balance:

Reason:

Select:

Increase

Decrease

Correct Balance:

Reason:

Comments:

Employee Data Sheet - Full Version

Social Security Number - DO NOT submit the SS# through e-mail. Please contact your HR Consultant if the SS# is required for a data change.

Phone Numbers

Email Addresses

Length of Service Adjustments

* Please FAX a copy of the front page of the review.

Sick

Vacation

Discretionary Day

Comp Time

Holiday Comp Time

Military