9
UNIFIED SCHOOL DISTRICT NO. 1 OF RACINE COUNTY BOARD OF EDUCATION RACINE, WISCONSIN NOTICE OF APPOINTMENT TO: LEHMAN JOHN H You are hereby notified that you have been appointed to a position in the Unified School District No. 1 of Racine County for the ' 971-1972 SCHOOL YEAR for which school year of services properly rendered you are to receive an annual salary of: .. 1—CURRENT—- $*7t500.00 level 04 step ° I provided that: You will provide evidence that you are legally qualified to fill the position through license or certificate as required by the laws of the State of Wisconsin. You will agree to abide by all rules and regulations now existing or which may hereafter and before termination of this contract be authorized or adopted by the Board of Education, You will be in a satisfactory state of health as indicated by an examination by a member of the Board of Education approved examining panel as required and paid for by the Board of Education, This contract is subject to the provisions of the laws of Wisconsin governing Teachers' Insurance and Retirement Fund and will be void unless a signed copy is received in the Office of the Superintendent of Schools BY APRIL 15, 1971. » BECAUSE NEGOTIATIONS ARE NOT COMPLETEfcATED MARCH lit 1971 THIS CONTRACT IS BEING ISSUED ON THE BASIS OF YOUR CURRENT PLACEMENT ON THE BOARD OF EDUCATION SALARY SCHEDULE AND THE SCHOOL BUAKU ur tuuuA i IUIN :ALENDAR. ONCE THE 1971-72 PROFESSIONAL AGREEMENT IS ADOPTED, YOUR SALARY AND BEGINNING AND ENDING DATES MILL BE ADJUSTED ACCORDINGLY. C. RICHARD NELSON APPFPTANPF FOR THE 1971-72 SCHOOL YEAR, YOU " uutr ««'«>- itlll BE PLACED AT LEVEL 04, STEP 015. I hereby occept^the offers stated in this contract anji. agree to abide by its provisions, and ! certify that I was born at SECTION 118.22-2 STATES THIS CONTRACT SHALL BE ACCEPTED OR REJECTED, IN {/ WRITING, BY APRIL 15, 1971. BOARD OF EDUCATION COPY

John Lehman-Resignation Paperwork

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This is paperwork regarding John Lehman's 1972 resignation from Racine Unified over his coniction for draft dodging.

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Page 1: John Lehman-Resignation Paperwork

UNIFIED SCHOOL DISTRICT NO. 1 OF RACINE COUNTYBOARD OF EDUCATION

RACINE, WISCONSIN

NOTICE OF APPOINTMENT

TO: LEHMAN JOHN H

You are hereby notified that you have been appointed to a position in the Unified School District No. 1 of Racine

County for the '971-1972 SCHOOL YEAR

for which school year of services properly rendered you are to receive an annual salary of:.. — — — 1— CURRENT— — — — - —$*7t500.00 level 04 step ° I provided that:

You will provide evidence that you are legally qualified to fill the position throughlicense or certificate as required by the laws of the State of Wisconsin.

You will agree to abide by all rules and regulations now existing or which mayhereafter and before termination of this contract be authorized or adopted by the

Board of Education,

You will be in a satisfactory state of health as indicated by an examination by amember of the Board of Education approved examining panel as required and paid

for by the Board of Education,

This contract is subject to the provisions of the laws of Wisconsin governing Teachers' Insurance and Retirement

Fund and will be void unless a signed copy is received in the Office of the Superintendent of SchoolsBY APRIL 15, 1971.

» BECAUSE NEGOTIATIONS ARE NOT COMPLETEfcATED MARCH lit 1971THIS CONTRACT IS BEING ISSUED ON THEBASIS OF YOUR CURRENT PLACEMENT ON THE BOARD OF EDUCATIONSALARY SCHEDULE AND THE SCHOOL BUAKU ur tuuuA i IUIN:ALENDAR. ONCE THE 1971-72 PROFESSIONALAGREEMENT IS ADOPTED, YOUR SALARY ANDBEGINNING AND ENDING DATES MILL BEADJUSTED ACCORDINGLY. C. RICHARD NELSON

APPFPTANPFFOR THE 1971-72 SCHOOL YEAR, YOU "uutr ««'«>-

itlll BE PLACED AT LEVEL 04, STEP 015.I hereby occept^the offers stated in this contract anji. agree to abide by its provisions, and ! certify that I was

born at

SECTION 118.22-2 STATESTHIS CONTRACT SHALL BEACCEPTED OR REJECTED, IN {/WRITING, BY APRIL 15, 1971.

BOARD OF EDUCATION COPY

Page 2: John Lehman-Resignation Paperwork

RUN DATE 11/30/71

CURRENT LEVEL-STEP NEW LEVEL-STEPSCH CONTRACT AMOUNT CONTRACT AMOUNT

JOHN LEHMAN 94 04-010 04-015$7t5QO.OO $7,650,00

A. FORMULA FOR CALCULATING GROSS AMOUNT PAID EACHPAY PERIOD.

1. OLD CONTRACT AMOUNT $7,500.00DIVIDED BY 186 CONTRACT DAYSMULTIPLIED BY 54 DAYS WORKEDDURING FREEZE EQUALS $2,177.26.ADD NEW CONTRACT AMOUNT $7,650.00DIVIDED BY 186 CONTRACT DAYSMULTIPLIED BY 132 DAYS TO WORK DURINGNEW CONTRACT PERIOD EQUALS $5,429.16.SUBTRACT $2,142.84 WHICH IS THE OLD GROSS AMOUNT PAIDEACH PAY PERIOD $357.14, MULTIPLIED BY THE NUMBER OFPAY PERIODS PAID 6. THIS EQUALS THE GROSS SALARY TOBE PAID BEGINNING NOVEMBER 15, 1971 $5,463.60.

$2,177.28 £ $5,429.16 - $2,142.84 EQUALS $5*463.60

2. DIVIDE AMOUNT TO BE PAID EMPLOYEE $5,463.60BY THE NUMBER PAY PERIODS REQUESTED 21 MINUS THE NUMBERPAY PERIODS PAID 6, EQUALS THE NEW GROSS AMOUNT TOBE PAID EACH PAY PERIOD $364.24.

8. FORMULA FOR DETERMINING AMOUNT OF RETIREMENT TO BEPAID BY SOARD EACH PAY PERIOD.

1. NEW CONTRACT AMOUNT $7,650.00DIVIDED BY 186 CONTRACT DAYSMULTIPLIED BY 132 DAYS TO WORKDURING NEW CONTRACT PERIODMULTIPLIED BY 4.5 % EQUALS $244.31, THETOTAL RETIREMENT EARNED NOVEMBER 15, 1971THRU JUNE 9, 1972.

•'.*!

2. OIVI06 TOTAL YEARLY RETIREMENT EARNED $244.31BY NUMBER PAY PERIODS REQUESTED MINUS 6, NUMBERPAY PERIODS PAID, EQUALS $16.29, THE AMOUNT OFRETIREMENT TO BE PAID BY BOARD EACH PAY PERIOD.

Page 3: John Lehman-Resignation Paperwork

FORM 668-A( R E V , FEB. 1967)

April 8, 1971

U. S. TREASURY DEPARTMENT - INTERNAL REVENUE SERVICE

NOTICE OF LEVY

rTO

Unified School District2230 northwestern AvenueRacine, Wisconsin 53404-

L_

1

Jr v 7 ̂

. / '7>vX . • ' . . . . , . ' . ; . •You are hereby notified,, tri'dwhose name .appeprs" Below

TAX FORMNO.

720

720

PERIOD ENDED

6-30-70

9-30-70

ORIGINATING DISTRICT

Milwaukee, Wisconsint ther^i is now .due, owing and unpaid to the United States of Aftie

DATE OFASSESSMENT

2-12-71

2-5-71

IDENTIFYING NO.

3969403000059

3969402300043

UNPAID «BALANCE OlfASSESSMENT

* 1.19

1.58

•STATUTORY'ADDITIONS

* .06

= < T , -• : ' i i'

t! ' -> • >

TOTAL AMOUNT DUE

rica from the taxpayer^2.88

'. ,;. , TOTAL

'•1.25'

|2,88:

You are further notified that demand has been made for the amount set forth herein upon the taxpayer, wK6' has neglectedor refused to pay, and ;that such amount is still due, owing, and unpaid from this taxpayer. Accordingly, you are furthernotified that all property, rights to property, moneys, credits, and bank deposits now in your (possession and belonging to thistaxpayer (or with respect to which you are obligated) and all sums of money or other obligations owing from you to this tax-payer, or on which there is a lien provided under Chapter 64, Internal Revenue Code'of 1954, are hereby levied upon andseized for satisfaction of the aforesaid tax,, together with all additions provided by law, and,demand is hereby made upon youfor the amount necessary to satisfy the liability.set forth herein, or for such lesser sum as ypu maybe indebted to him, to beapplied^as a payment on his tax liability. 'Checks or money orders should be made payable 'tc» "Infefnal'Revenue1 Service".

SIGNATURE M~ /-' jf'3"*J*l TITLE

Eerecue OfficerADDRESS (CITY Af~lD STATE)

Racine^ VHacemsAM 53403

. . , „ - , CERTIFICATE OF SERVICE

(Name and Address of Taxpayer)

r

L

JOHN WARREN LEHMAN"1

J

I hereby certify thai lhi« levy wot served by

delivering a copy of Ihis notice of levy lo the

person named below.

NAME

J2_

PART 3 — TO BE FURNISHED TO TAXPAYER (REV. 2-67)

Page 4: John Lehman-Resignation Paperwork

EXCERPTS FROM THE INTERNAL REVENUE CODE

SEC. 6332. SURRENDER OF PROPERTY SUBJECT TO LEVY.

(a) REQUIREMENT.—Except as otherwise provided in subsection (b),any person in possession of (or obligated with respect to) property orrights to prope'rty subject to levy upon which a levy has been made shall,upon demand of the Secretary or his delegate, surrender such propertyor rights (or discharge such obligation) to the Secretary or his delegate,except such part of the property or rights as is, at the time of such de-mand, subject to an attachment or execution under any judicial process,

(b) Special Rule for Life Insurance and Endowment Contracts.

(1) In general.—A levy on an organization with respect to a life in-surance or endowment contract issued by such organization shall, withoutnecessity for the surrender of the contract document, constitute a de-mand by the Secretary or his delegate for payment of the amountdescribed in paragraph (2) and the exercise of the right of the personagainst whom the tax is assessed to the advance of such amount. Suchorganization shall pay over such amount 90 days after service of noticeof levy. Such notice shall include B£ certification by the Secretary or hisdelegate that a copy of such notice has been mailed to the .person .against whom 'the''tax is" 'assessed at His last 'known aeTd'ress.' :

(2) Satisfaction "of levy.™Such levy shall be deemed to be satisfiedif such organization pays over to the Secretary orchis delegate theamount which the person against iWhonrt,-the tax is assessed could havehad advanced to him b^ such organization on the dale prescribed inparagraph (3) for the satisfaction of such levy, increased by the amountof any advance, {including contractual interest thereon), made to suchperson on or after the date such organtestion had actual notice or knowl-edge (within thft meaning of section 6323(0 (1)) of the existence of thelien with resjttfiU fo. whibh sueljf levy is made, other 'than an advanced(including contractual interest thereon) made automatically to maintainsuch contract in force under an agreement entered into before suchorganization had such notice or knowledge, ,

(3) Enforcement proceedings.—The satisfaction of a levy . underparagraph (2) shall be without prejudice to any civil action for the en-forcement of any lien Imposed by this title with respect to' suchcontract.

fc) ENFORCEMENT OF LEVY.— ^^(1) EXTENT^ OF PERSONAL LIABILITY.—Any person who fails or

refuses to surrender any property or 'rights* to 'property, subject to'feVy,upon de'mand by the'Secretary"or his delegate, shall "be liable in hts ownperson, and -estaterto; the United < States ,tn a.i sum equal ,to tbe'vaiue ,ofthe property or rights not so,surrendered,,but not exceeding the amount ,of taxes for the collection of which such levy has been made, togetherwith costs and interest "on such sum at the rate of "6 'pe^cVnt per anrib'mfrom 'the*date' of'such levy/ -Any ^amount (other "than"!£bsts) recoveredunder ihisrvparagraph tshalh be^eredited .against the tax liability tfortjhen

collection..of;.which suck,levy-was made,orl »^,r**.« $*\ MuoiU " ''•" » * •

(2) PENALTY FOR VIOLATION.—In addition to the personal liabilityimposed by paragraph '(l)/:tf any person reefuired''to surrender propertyor rights to^property fails.ot^efuses to surrender such property or rightsto property ^without reasonable cause, such* "person shall be liable" for*apenalty equal to 50 percent of the amount' recoverable under paragraph(1). No pa>t*lof sudh^penelty shall be credited against the tax liabilityfor the collection of which such levy was made.

(d) EFFECT OF ;HONORING LEVY.—Any person in possession of(or obligated with respect to) property or :rights to property subject tolevy upon which a levy has-been made :wnb, upon demand by the Secre-tary or his delegate, surrenders s'uch property or rights to property (ordischarges such obligation) to the Secretary or his delegate (or who paysa liability under subsection (c) (1) } shall be discharged from any obli.gation or liability to the delinquent taxpayer with respect to such proper-ty or rights to property arising from such surrender or payment. In thecase of a levy which is satisfied pursuant to subsection (b), such organi-zation shall also be discharged from any obligation or liability to anybeneficiary arising from such surrender or;payment.

SEC. 6334. PROPERTY EXEMPT FROM' LEVY.

(a) ENUMERATION.—There shall be exempt from levy—

(1) Wearing Apparel and School Books.—-Such items of wearing ap-parel and such school books as are necessary for the taxpayer or formembers of his family;

(2) Fuel, Provisions, Furniture, and Persona] Effects.—If the tax-payer is the head of a family, so much of the fuel, provisions, furniture,and personal effects in his household, and of the arms for persona! use,livestock, and poultry of the taxpayer, as does not exceed $500 in value;

(3) Books and Tools of a Trade, Business, or Profession.—So manyof the books and tools necessary for the trade, business, or profession ofthe taxpayer as do not exceed in the aggregate $250 in value.

(4) Unemployment Benefits.—Any amount payable to an individualwith respect to his unemployment (including any portion thereof payablewith respect to dependents) under an unemployment compensation lawof the United States, of any State or of the District of Columbia or ofthe Commonwealth of Puerto Rico.

(5) Undelivered MaU.—Mail, addressed to any person, which hasnot been delivered to the addressee.

*(6) Certain Annuity and' pension Payments. — Annuity or'pensjon* payments ufTder the Railroad Retirement-Act, benefits under the Railroad

Unemployment Insurance Act, special pension payments received by aperson whose name has been entered on the Army, Navy, Air Force, andCoast Guard Medal'of Honor roll (38 U.S.C. 562), and annuities basedon retired or retainer pay under chapter 73 of title 10 of the United

.States Code.,t! ry^ i/~ „ . j V

(7) Workmen's Compensation. — Any amount payable to an indi-vidual as workmen's compensation (including any portion thereof, pay-

^••able-with respect to dependents) under a workmen's compensation lawof the United States, any State, the District of Columbia, or the Com-monwealth of Puerto Rico.

SEC. 6343. AUTHORITY TO RELEASE LEVY AND RETURN PROPERTY.

(b) Return of Property. — If the Secretary ot his delegate determinesthat property has been wrongfully levied upon, it shall be lawful for theSecretary or his delegate to return—

(1) the specific property levied upon,

(2) an amount of money equal'Vo the amount of money levied• ; " " - ' upah, or " 8 : ''i •*"> *> *U-

(3) an amount1 of money'equal to the: Bnidunt of money received* by the United States from a sale of such property. .' '

Property'may be returned at any time. An amount equal to the Amountof money levied upon or received from such sale may be returned at any

;jtimeibefore' the .expiration of Qimonthstfrom.the date ,of such levy. For .^purposes-of paragraph ,(3),; if property is declared-purchased , by .theUnited States at a saie pursuant to section 6335(e)v (relating to mannerand conditions :0f sale), the United States shall be treated as haying re-ceived an amount of money equal to the minimum price determined pur-

*suah't td'suctV section or (if larger) the amount received by the UnitedStates from the resale of such property.

APPLICABLE SECTIONS OF INTERNAL REVENUE CODE

6321. Lien for Taxes.6332. Period of lien.6325. Release of lien or discharge of property.6331. Levy and distraint.6332. Surrender of property subject to levy.6333. Production of books.6334. Property exempt from levy.6343. Authority to release levy and return property.7426. Civil actions by persons other than taxpayers.

FOR ADDITIONAL INFORMATION CONCERNING THIS NOTICE OF LEVY,PLEASE CONTACT THE PERSON WHOSE SIGNATURE APPEARS ABOVETHE NAME AND ADDRESS OF TAXPAYER.

FORM 668-A (REV. 2-67)

Page 5: John Lehman-Resignation Paperwork

UNIFIED SCHOOL DISTRICT NO. 1 OF RACINE COUNTYBOARD OF EDUCATION

RACINE, WISCONSIN 53404

INDIVIDUAL CONTRACT*

TO:

You are hereby offered a position with Unified School District NO. 1 of Racine

County for the terrn/beginning i r ) - " 2 - ? SCHOOL : i / and ending

for which period of services properly rendered you are to receive a salary of:

$ ' , , ; , ; , ; < (level o '• step •:> \ . - ), provided that:

You will provide evidence that you are legally qualified to fill the positionthrough license or certificate as required by the laws of the State of Wisconsin.

You will agree to abide by all rules and regulations now existing or which mayhereafter and before termination of this contract be authorized or adopted bythe Board of Education.

You will be in a satisfactory state of health, as indicated by an examinationby a member of the examining panel designated by the Board of Education.

This contract is subject to the provisions of the laws of Wisconsin governing Teachers' Insurance andRetirement Fund.

The offer contained herein will be void unless the signed copy of acceptance is received in the Office of theSuperintendent of Schools within ten days of this date.

• ;, ;UJ-.,f- N- ' -C- . 'T I AHGNS AHt NO! l'UM.p|, f 1 f.O,O.J:YJr>> ( ii ISSUri ON THt; HA*, IS nATEQ MARCH j 3 . ; y r,

M » » l A C C M i : N r pw THt; BOARD OF EDUCATION• • • - « ' • • > ' i ' ' ' H i r , I H | v u K i - t - K !U COST K A;". I

"; A ( s . \ s - T t O UK KtrJ f l , l t d !« w K S r ( f - i ( ;"^ i :.- ! :• , l-i'f I, By

SUPERINTENDENT OF SCHOOLS

ACCEPTANCEI hereby accept the offer as stated in this contract, and agree to abide by its provisions.

I certify that I was born at:

'.' // / .1 < /: y*.//' j '.i -•'/ .•' A' fi .••• ..•/'-,<. nn • //'//.•// .* /'.' /: .:": A' //.-:...•/-,< . nn ' //' / f';U i /''C*TATC * * ' * fa/sir^l."CITY ""STATE"' " MONTH DAY YEAR

Signed"Terms are subject to the provisions of any applicable •, , ,collective bargaining agreement. Date ,t ' '• •'—,'_', !—

WHITE—RETAIN THIS COPY YELLOW-BOARD OF EDUCATION COPY

Page 6: John Lehman-Resignation Paperwork

Unified School District #1 of Racine County

PAYROLL ACTION REQUEST

Social Security #_

Name /-• f >' * DateLast

Address

First Middle

Street

Effective Date

City State Zip

New Termination

New Step & Level

-7 if, /Type

Account it

Reason

School #

New Contract Salary

Salary Change Transfer__

(List all account number(s)that the above individualshould be charged to.Note that sum total shouldequal 1005Q

If Federal Program Specify_

Signature (Federal Program Director)I],/ AJU. =

Signature (Personnel Department

INSTRUCTIONS

Type or Print

1. New Employee — Fill in all applicable spaces.Under type identify position by using a, b, c, or d below.a. Teacher, Principals, Administrators (State Teachers Retirement only)b. Substitute Teachersc. Aides, Secretaries, Administrators, or any substitute (Wisconsin Retirement)d. Custodian, Maintenance, Cooks

2. Salary Changea. Name & SS#

3. Transfera. Name fc SS#

4. Terminationa. Name & SS#

b. Effective date

b. Effective date

b. Effective date

c. New salary

c. New work location

c. Reason

Page 7: John Lehman-Resignation Paperwork

SCHEDULE OF PERSONNEL CHANGESUNIFIED SCHOOL DISTRICT NO. 1 OF RACINE COUNTY

New Appointments - 1970-71 School Year January 11, 1971

Names

Azarian, NedBraun, CarolynBurgos, FerminConroy, Patricia L.Fazen, LynnFisher, SharonFornal, RichardGedemer , LynnHochhausen, LoisJonokuchl , LynnKlausmeier, ThomasLehman, JohnLeuck, John P.Marcoe, John E.Might, Margaret L.Nitz, Carole J.Potter, Mary L.Ricketts, Steven R.Roland, Mary, Mrs.Salvo, Barbara, Mrs.Schuett, SusanSpencer, John R.Tatman, MaureenTurner, DonnaZimmerman, Dean

Position

s.s.5-6S.S.Phy Ed.3156K3S.S.S.S.MathMath3MathMathS.S.EnglishMathKInd. Arts14Science

College

OshkoshU. of WisconsinLaCrosseLaCrosseColorado U.Northern StateCarthageEau ClaireStoutU. of WisconsinU. of WisconsinLuther Col.UW - ParksideMarquetteUW - ParksideStevens PointDominicanU. of WisconsinUW - ParksideU. of WisconsinLaCrossePlattevilleWhitewaterOklahoma StateUW - Milwaukee

DateEffective

1/25/711/25/711/25/71I/ 4/711/25/71I/ 4/71I/ 4/711/25/711/25/711/25/711/25/711/25/711/25/71I/ 4/711/25/711/25/7112/21/701/25/711/25/711/25/711/25/711/25/711/25/711/25/711/25/71

SalaryRate

7500750075007500750075007500750075007500750075007500750075007500868175007500795075007500750075003300

Tr.-Exp.

4-14-14-14-14-14-14-14-14-14-14-14-14-14-14-14-14-44-14-14-2}s4-14-14-14-17-1(80%)

Age Remarks

232322262221 Reinstated2222212222252223222725223823 Former Emp2523222239

New Appointments - Administration - 1970-71 Fiscal Year

Herrera, Anita C.O.P. Assistant

Returning from Leave of Absence - 1970-71 School Year

Black, KennethVerbeten, Karen, Mrs.

Phy Ed - Wadewitz6 - McKinley Ele.

12/21/70 6500

I/ 4/71 8100 4-31/25/71 10331 4-8

Page 8: John Lehman-Resignation Paperwork

Schedule of Personnel Changes- 3 September 11, 1972

New Appointments(Non-ContractedBasis) - 1972-1973 School Year - Continued

Dates, Judith L., Mrs. Unified Studies (Starbuck - 50%). 8/28/72 4960 7-5Woodard, Suzanne W., Mrs. Social Work (Pupil Personnel - 62.5%) 8/28/72 4875 4-2

Changes - Administration - 1972-1973 School Year

Young, Stella, Mrs. From Administrative Assistant, Stephen Bull Elementary School, toDirector, Headstart Program

8/24/72 15820 1-2\

Changes - 1972-1973 SchoolYear -

Gall, Janet H., Mrs. From 60% to 40%, Jerstad Jr. High School, effective for the 1972-1973School Year

Madahgian, Hildegarde, Mrs. From full-time to 50%, Sturtevant Elementary School, effective for the1972-1973 School Year

Zirkelbach, Barbara A., Mrs. From 60% to 80%, Horlick High School, effective for the 1972-1973 School^ Year

Resignations - 1971-1972 School Year

Anthony, Barbara A. Speech Therapy 8/22/72DeMark, Ann C. , Mrs. K - West Ridge 6/ 9/72Gerdel, Kurtis D. . Phy Ed. - Gifford 8/21/72Heidenreich, Richard R. 6 - Janes , 8/16/72Hengst, Frederick A. Unit C - Jones 8/25/72Hutchings, Jennifer, Mrs. Speech Therapy , 8/16/72Lehman. John W. S.S. - Park 8/18/72̂Manglos, Glaye E., Mrs. Special Ed. - Lakeside -. 8/16/72Mills, Jon B. Business Ed. - Mitchell Jr. 8/16/72Unwin, Kenneth J. 6 - Lincoln , 6/ 9/72Whitis, Natalie J. . . Mathematics - Jerstad Jr. ,- 8/16/72

Leaves of Absence - 1972-1973 School Year

McMullen, Barbara C.,,Mrs. English - Gifford Medical

Page 9: John Lehman-Resignation Paperwork

Unified School District #1 of Racine County

PAYROLL ACTION REQUEST

Social Security #J

Name '-Last

AddressStreet

Effective Date

.'

New /"Type

Account #

DateFirst Middle

City State Zip

New Step & Level

TerminationReason

School #

Salary Change

New Contract Salary

Transfer

(List all account number(s)that the above individualshould be charged to.Note that sum total shouldequal 100%̂

If Federal Program Specify^

Signature (Federal Program Director) Signature (Personnel Department

INSTRUCTIONS

Type or Print

1. New Employee — Fill in all-applicable spaces.Under type identify position by using a, b, c, or d below.a. Teacher, Principals, Administrators (State Teachers Retirement only)b. Substitute Teachersc. Aides, Secretaries, Administrators, or any substitute (Wisconsin Retirement)d. Custodian, Maintenance, Cooks

2. Salary Changea. Name & SS#

3. Transfera. Name & SS#

4. Terminationa. Name & SS#

b. Effective date

b. Effective date

b. Effective date

c. New salary

c. New work location

c. Reason