City of Northampton
Report of Personnel ActionHRD2
EFFECTIVE DATE OF CHANGE _______________
EMPLOYEE NAME: ___________________________________EMPLOYEE #____________________
ACTION:
Appointment/New Hire
Appt. Additional Pos.
Transfer
Promotion
Name/Address Change
Shift Change
Pay Adjustment
Reinstatement
Separation
Change in Skill Pay
Suspension
Leave of Absence
DEPARTMENT INFORMATION (CURRENT):
DEPARTMENT INFORMATION (NEW):
DEPARTMENT\DIVISION
DEPARTMENT\DIVISION
POSITION TITLE
POSITION TITLE
POSITION#
POSITION#
BARGAINING UNIT
BARGAINING UNIT
GRADE
GRADE
STEP
STEP
SALARY
SALARY
ORG.#
ORG.#
OBJ.#
OBJ.#
APPOINTMENT:
# Regular scheduled hours per week
OR
Intermittent hours
Permanent (lasting > 6 months)
OR
Temporary (lasting < 6 months)
SEPARATION:
Resignation
Termination
Lay Off
Appointment Expired
Other (explain below)
LEAVES OF ABSENCE:
Suspension
Leave of Absence
FMLA
Lay Off
- Investigatory
- Disciplinary
With Pay
Without Pay
Start Date
End Date
EXPLANATION/DETAIL:
AUTHORIZATIONS (as required):
_________________________________ Date: _________ ______________________________________Date:_____________
Department Head Human Resource Director
IMPORTANT please complete the next page…
HRD2 - Revised 7/11/03, 9/16/15
City of Northampton
Report of Personnel ActionHRD2
For Information Technology Purposes
EMPLOYEE NAME: _________________________________ DEPARTMENT: ___________________________
Position/Job Title: ___________________________________
Adding Service if adding service please state who is being replaced____________________________________
Removing Service
Date of Service to be Added or Terminated: __________________________________________________________
Phone Service Phone Number _________________________
Computer Hardware:
Desktop PC
Monitor
- size __________
Standard size is 20”
- Dual monitors ________
Printer
- Networked Printer
- Desktop Printer
Scanner
Other
(explain below)
Software/User Accounts:
Microsoft Office Suite
GeoTMS
Munis
City Website
Gmail
Laserfiche
Vueworks
Other (explain below)
Northamptonma.gov Website Access:
Website account
Permission Levels
For a description of each level click here (must be logged into website to see)
- Owner
- Publisher
- Author
Please indicate the main email distribution groups the employee should be added to or removed from:
Munis Users Group
Financial Management Team
Department Head Group
City Website
GeoTMS
Other (explain below)
Depending on the selections made above IT may schedule training sessions prior to activating a new user.
An email must be sent to Emergency Dispatch to add or remove an employee to the Employee Emergency Alert
Notification Group.
EXPLANATION/DETAIL, IF NEEDED:
AUTHORIZATIONS (as required):
_________________________________ Date: _________ ______________________________________Date:_____________
Department Head IT Director