Free ARIZONA DEPARTMENT OF ADMINISTRATION - Arizona

ARIZONA DEPARTMENT OF ADMINISTRATION HUMAN RESOURCES DIVISION AUTHORIZATION REQUEST FOR STIPEND/SALARY ADD ON
AGENCY: REQUEST TO:

Add a Stipend Remove a Stipend

REASON FOR REQUEST:

CRITERIA FOR ELIGIBILITY: (BE SURE TO INCLUDE JOB CODES AND IF NECESSARY, PROCESS LEVELS, DEPARTMENTS, AND EMPLOYEE STATUSES)

PROPOSED/EXISTING AMOUNT: (SELECT ONE CHECKBOX AND FILL IN AMOUNT)

$_______________________ per hour

($_______________________ per year)

$_______________________ flat amount (one time payment) _______________________ % of base salary
PROPOSED EFFECTIVE DATE:

Submission of this request certifies that funds are available to implement this change if approved.

Agency Head or Designee

Date

For ADOA HRD Central Use Only

Name of Stipend/Salary Add On: Affected Agencies: Effective Date: Eligible Class(es): Comments: Approved CCB Notified Denied By:

Amount:

Pay Code:

Date:

Revised: 02/09