Position & Personnel Database (Ppdb) Temporary Service Worker Request Form - Oregon Department Of Administrative Services

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Position & Personnel Database (PPDB)
Temporary Service Worker Request Form
Agency#
Agency Name:
WORKER INFORMATION
Name
Last, First M.I.
Start Date:
**End Date:
Supervisor Authorization Number:
Supervisor:
Supervisor Phone:
Supervisor Email:
Ext.
Reaso n for Request:
Job Rotation- EIN: OR
Contract Worker
Volunteer
Interagency Contract
Other, Please explain:
Extending Temporary Service Worker End Date:
**The effective end date is required for all temporary service worker records.
If the active term of the temporary service worker record needs to be extended past the original end date
th
described above then a request for extension must be received no later than the 15
of the month of the
original end date. There is no exception to this. Once a temporary service worker record has been
terminated it cannot be reinstated. If a temporary service worker record is still required you must submit a
new request.
The Temporary Service Worker Record and User ID in no way implies or assures a subsequent
appointment to any permanent, seasonal or limited duration position with the agency nor does it
establish any status as an employee of the State of Oregon.
Agency Security Officer or Appointing Authority Signature:
Date:
This form may be submitted electronically by the Agency Security Officer or Appointing Authority however the signed
original must be retained on file by the agency per OAR 166-300-0010 State Agency General Records Retention
Schedules.
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