Reduction in Force

Please complete this form for your RIF candidates.

Agency/University*

Select

Approval Date (University Submissions Only)

(University Submissions Only)

Agency Type*

Select

Division*

Please enter the employee's working d

Employee Last Name*

Employee First Name*

Personnel #

Notification Date*

Date Employee was notified of RIF

RIF Separation Date*

Severance/DSR*

Please indicate the amount the agency is requesting to pay. If requesting Severance enter the Severance amount. If requesting DSR enter the DSR amount.

Severance Type*

Please indicate whether the agency is requesting to pay RIF Severance or DSR

Select

Priority Information

Appointment Type*

Please indicate whether the employee worked full time or part-time.

Select

Career Status*

Has the RIF candidate achieved Career Status

Yes

Hours per Week*

Enter the number of hours per week the employee worked

Job Code*

Enter the Job Code for the RIF Candidate's position

Classification

Enter the Job Classification for the employee's position.

Salary Grade/Band Level*

Enter the Salary Grade or Band Level for

Annual Salary*

Enter the Employee's annual salary at the time of the RIF

Work Location Address*

Please enter the applicant's work address

County Name*

Please indicate the County the employee worked in.

Select or enter value

Agency Comments

File Attachments*

Please attach the following documents for OSHRs review: RIF Severance request form This two page document should be saved as a pdf file. RIF Plan and Checklist- The RIF Pland and OSHR RIF Checklist should be saved as one .pdf file DSR Letter - If the employee is eligible for DSR you must attach the DSR letter from the retirement center. this document can be saved as part of the Severance/DSR file. Your request will be returned if the employee is eligible but letter is not attached.

Drag and drop files here or

Submitted By*

Submitted by Email*

Submitted by Phone*

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