NOSVEH arm 0N3 aura mus A8019 BONESEIV EHIH NEIN LISIQ NOILOV AHOLSIH L180 WHELL 9 50 9 L0 LIQO HHIH NEIN HALLOV 9 60 ?3 L0 NEELLNI WHEJ. 0 19 690 L919 171.08] 11190 LIED EHIH MEN EALLOV 0 18 690 Oi INOEH NOILOV IN 13 I18 ldElCl 31111 AHOLSIH n'a 90 L9 MID -9L0 BALLOVNI IN omvwaamv - NHEJLNI maanis-Qovo a'uu anr AHOLSIH MHOM 8 1ueweBeuew spJooea semnosea ueumH ;o 1ueLu1Jedec] o?eomo 40 Ana City of Chicago Department of Human Resources Records Management EMPLOYEE 11/20/2018 WORK HISTORY Termination Reason Termination Date - Actual DISCHARGE 5/21/14 TERMINATION 8/11l17 DATE ACTION TC DEPARTMENT PAYROLL ST PAYRATE Noti?cation Details E?Business Oracle Applicatlons Home Page Worklisi 059-4113: 606 and, LI Reinstatement "Beds ?rmer?! for AN, E94809 __Bagig Step 53 of 75 Ne? cc-Ep From To DISPLAY Sent 19-Mar-2014 14:40:10 ID 93636057 Summary Effective Date 17-Mar-2014 Employee Name LOPEZ, JUAN Manager SONYA Department 059-4113 FIRE SUPPRESSION AND RESCUE :3 Indiana Changed items. 3' Assignment Current Department 059-4118 FIRE SUPPRESSION AND RESCUE Job 873 IIFIREFIGHTER Worker is a Manager No Posltion Name Home Worker No Location 059-4118 FIRE SUPP Grade Name Payroll Name GoVernment Reporting Entity Tlmecard Required EMPLOYEE STATUS 0 EMPLOYEE SUFFIX 00 FLSA CODE ACTUAL JOB PAID AS 8731 BARGAINING UNIT UNION DUES DEDUCTION CODE LOCAL COMMENTS PENSION 4 Pension Tier 2 GRANT Assignment "Status Acme Assignment Change Reason Appointment - New Hire Salary Basis: Work Hours 40.76 Frequency Week Assignment Category Union Member No Probatlon Period 9 Probation Unit Months Probation End Date 16?Dec-2014 Primary Assignment Yes Pay Rate Current Appointment - New Hire Pay Rateo?o USD Pay Rate Annual Equivalent 0-00 USD Page 1 of2 Home Logoul Preferences Help Worklist for DECKER, GRACE we? ?miss! jgyeti?fe?ra?rn Employee Number - Organization Email Address Job 3731 FIREFIGHTER Proposed 0594118 FIRE SUPPRESSION AND RESCUE 873 ll FIREFIGHTER No No 059-4118 FIRE SUPP PAY01 CITY OF CHICAGO - GREiib N0 {3 0 00 8731 B7 {5 H9 FIREFIGHTERS UNION, LOCAL 2.FSHR :93 4 2 CORPORATE Active Appointment New Hire SALARY 12; 40.76 Week Fulltime?Regular No 9 Months 16-Dec-2014 Yes Proposed 4,207.50 USD 4,207.50 50,490.00 USD http://chl 3/20/20] 4 Noti?cation Details Page 2 of 2 Salary Effective Date 17-Mar-2014 Comrnenm APPOINTMENT NEW Extra Information Type Preposed PAYROLL SUB GROUP 1230 PAYROLL PAYROLL UNIT NUMBEROOZ PAYROLL SEQUENCE NUMBER 0000 PAYROLL DEPARTMENTOSQ-FIRE DEPARWEN PAYROLL DIVISION CANDIDATE TRAINING PAYROLL DIVISION HEAD JOSE A SANTIAGO PAYROLL DIVISION HEAD TITLE FIRE COMMISSIONER History Sequence Name Action Date Notes :1 HAMMOND, KEYANNA Submit 19-Mar-2014 11:18:36 ?22 BRYANT, ADRIANNE Approve 19~Mar-2014 14:05:05 3 HLSCOMM059 Accepted 19+4ar-2014 14:40:10 BRYANT, ADRIANNE Resmnso Approval Comment f373p??j??2?itj er Pat-?K Ste0530f75?77 ficee?md liei?s?teil?keas??" Privacy Statement Copyrinhl 2006. Oracle All righls reserved http://ch 1 fmps4.cityofchicag0.org 3/20/20 [4 CITY OF CHICAGO DEPARTMENT OF HUMAN RESOURCE- PERSONNEL FILE PART II HIRING PAPERWORK CHECKLIST Name of Selected Candidate: LOPEZ, JUAN Department: FIRE Job Title: FIREFIGHTER Dept. A-Form Request ass-2014423 Requisitibn 7 (Example: oaa-zooa-om) {Examplez #143223) a 6' I I REQUIRED: Complete Selquervice Per 11 in CHIPPS (Upon receiving an e-mail from lnfonnation Service Division) Candidate Selected for LResidency Af?davit l-9 Hire Certi?cation Form (New Hires Only} (New Hires Only) {New and Current Hires) Commitment to Follow the City of Ethics Pledge EEO Policy Chicago?s Code of Conduct Acknowledgement Form DISCLOSURE RELEASE FORM - CLEARED YES no {New res Recallszehires over 90 Days) El'lilP OYEE STATUS (1 (2)Provisiona (3)Exempt by Ordinance (4)Dept Exempt Service (6)Exempt Program (7)Emergency (8)Exem pt Confidential (9)Exempt Seasonal =pA-u - Background Check Education Reference Indebtedness Criminal Background Clerk @Recruitermecruiting Analyst Effective Date: Initials Initials PLEASE RETURN THIS FORM ALONG WITH THE REQUIRED PAPERWORK TO: DEPARTMENT OF HUMAN RESOURCES Employment Services 121 North LaSalle Street Room 1100 Chicago, 60602 Revised on 03-13-13 CITY OF CHICAGO DEPARTMENT OF HUMAN RESOURCES DIVERSITY AND EQUAL EMPLOYMENT OPPORTUNITY DIVISION Diversity and Equal Employment Opportunity Policy Acknowledgement of Receipt I acknowledge that I received a copy of the City?s Diversity and Equal Employment Opportunity Policy on the date listed below. Print Name: \V/Z/jgg dry/Z- Employee ID number: I Department: A NOTE: If you have questions about the Diversity and Equal Employment Opportunity Policy, or wish to file a complaint, please contact the Department of Human Resources at 312-744?4224 or eeodiversity?cityofchicaqoorg ETHICS PLEDGE PURSUANT TO ?2-156-105 OF THE GOVERNMENTAL ETHICS ORDINANCE As a condition. and in consideration, of my employment or appointment by the City of Chicago in a position invested with the public trust, i shall, upon leaving government employment or appointment, comply with the applicable requirements of Section 2456405? of the Chicago Municipal Code imposing restrictions upon lobbying by former government employees, which I understand are binding on me and are enforceable under law. I acknowledge that Section 2456-105" of the Chicago Municipal Code, which I have read before signing this pledge, imposes restrictions upon former government employees and appointees and sets forth the methods for enforcing them. I expressly accept the applicable provisions of Section 2-156?105* of the Chicago Municipal Code as part of this agreement and as binding on me. I understand that the terms of this pledge are in addition to any statutory or other legal restrictions applicable to me by virtue of government service. 2-156-105. Post-employment Restrictions on Lobbying. Any person who serves as a non-clerical employee of the Of?ce of the Mayor, or (ii) a department head, shall be prohibited from lobbying the City of Chicago or any city department, board or other city agency for a period of two years after leaving that position. Any employee who holds an exempt position in a City department, board or other city agency on or after May 16, 2011, other than a person described in subsection of this section, shall be prohibited from lobbying the department, board or agency in which he or she was employed for a period of two years after that employment ends. (0) Any person who is appointed by the Mayor to the board of any board, commission, authority or agency, on or after May 16, 2011, shall be prohibited from lobbying that board, commission, authority or agency for a period of two years after the date on which his or her service on the board ends. The prohibitions on lobbying set forth in this section shall not apply to any person who occupied the position before May 16, 2011, and (ii) resigned from that position before November 16, 2011. Nothing in this section shall be construed to prohibit a person from oijying on be I of, and while employed by, another government agency. l?iz? ea 0 Mair; #4996 I Printizti Name 342% Date Commitment to Follow the City of Chicago?s Code of Conduct As a condition and in consideration of my employment by the City of Chicago, hereby commit myself to follow the City?s Code of Conduct, pursuant to ?2-156-005 of the Municipal Code of Chicago: The code of conduct set forth in this section shall be aspirational and shall guide the oonduct of every of?cial and employee of the City. As an employee of the City. I shall: (1) remember that i am a public servant who must place loyalty to the federal and constitutions. laws. and ethical principles above my private gain or interest. (2) give a full day's work for a full day's pay. (3) put forth honest effort in the performance of my duties. (4) treat members of the public with respect and be reSponsive and forthcoming in meeting their requests for information. (5) act impartially in the performance of my duties. so that no private organization or individual is given preferential treatment. (6) refrain from making any unauthorized promises purporting to bind the City. (7) never use any nonpublic information obtained through the performance of City work for private gain. (8) engage in no business or financial transaction with any individual. organization or business that is inconsistent with the performance of my City duties. (9) protectand Conserve City property and resources. and use City property and resources only for authorized purposes or activities. (10) disclose waste, fraud. abuse. and corruption to the appropriate authorities. (11) adhere to all applicable laws and regulations that provide equal opportunity for all persons regardless of race, color. religion. gender. national origin. age. sexual orientation. or handicap. i understand that this document is not intended to. and does not. create any right or bene?t, substantive or procedural. enforceab at law or equity. by any party against the City. its departments. agencnes. entities, of?cers. mployees agents: or an other person. - 93K Printed Name 3- It! Date Print Fa?r?m CITY OF CHICAGO DEPARTMENT OF HUMAN RESOURCES EMPLOYEE RESIDENCY AFFIDAVIT Department: Bureau: Name: Position Title: Employee Number- I understand and acknowledge that as a condition of employment with the City of Chicago I must be an actual resident of the City of Chicago. My address is:- City State& Zip I understand that the falsi?cation of this statement of address shall constitute grounds for discharge from the City Service. I understand and acknowledge that I must report any change of address immediately to my department head and to the Department of Human Resources and that failure to provide such noti?cation shall constitute grounds for discharge from the City Service. By signing this residency af?davit, I acknowledge and represent that I have fully read and understand both the front and reverse sides of this residency af?davit, and ?irther certify that the information which I have provided herein is true and correct. Si gnu m? NOTE: the new employee must provide proof of address in the form of a driver?s license or state issued ID, or mortgage statement, or bank statement, or water bill, or utility bill to the hiring department. Complete and sign two copies. First copy to department ?le. Second copy to Department of Human Resources. PER 60 2/25/2013 City of Chicago Policy on Residency as 3 Condition of Employment In order for a City employee to be most effective, he or she must identify with the needs and aspirations of the residents of the City of Chicago. This sense of identi?cation can only be accomplished if the employee is, in fact, an actual resident of the City. As a City resident an employee participates directly in the activities of a neighborhood of the City. This participation and commitment is essential to the development of a strong sense of public service as it relates to the citizens of Chicago. It has been and will continue to be a requirement for City employment that all employees of the City, irrespective of the status, shall be actual residents of the City of Chicago. This policy is stated in Section 25-30 ofthe Municipal Code of Chicago, the Rules of the Department of Human Resources and other departmental rules or labor contracts governing particular classes of employees. It is essential that this policy be applied uniformly to all employees in all departments. It is the reSponsibility of every department head to ensure that this policy is carried out. A department head shall take immediate action for the discharge of any employee not in compliance with the requirement that he/she be an actual resident of the City of Chicago. Any request for assistance in the implementation of this policy should be directed to the Commissioner of Human Resources. For your information an opinion of the Corporation Counsel states in part: ?actual residence has been found to contemplate substantially the same attributes as are intended when the word ?domicile? is used, and a permanent and fixed character is intended.? . .an actual resident has been held place with the intent to establish there his domicile or permanent residence.? The opinion goes on to say: . .the acquisition ofa local address solely for the purpose of claiming it as a residence as a requirement of public employment must be viewed as a subterfuge designed to avoid the obvious objectives of the ordinance. What is required is that the employee actually dwell at the purported residence, not that he have a mailing address at which he/she may on occasion spend some minimal amount of time, while, for example, his/her family lives outside the city and his/her children attend schools outside of the city in which the employed parent purports to reside.? Most recently the Illinois Supreme Court, in upholding the City?s residency requirement, described actual residence as a person?s ?true, permanent home? and ?principal residence (and) domicile.? PER 60 2/25/20l3 . Hire Certi?cation Form Candidate Name: Juan LOPEZ Job Title; Fire?ghter (if known) 05 9?20 4- Dept- Request #1 Title Code: 8731 Hire Type: ENon-Intewiew [Ulnterview HStudent [EVolunteer (Example: 033-2008-001) 059 EOther CAREERS Requisition Dept. (Example: #143228) Poiiticai reasons or factors snail not piay a rare in hiring. Poiiticai reasons or factors include any citric foiiowing: . 1 Recommendations for hiring, promotion or outer employment techs of speci?c of?ce holders or political party of?cials that not-based on knomedge of the job apolitarifs work skills". wort: experience. or other job-related quali?cations. (But sum recommendations irorn'pubiic of?ceholders or political party of?cials-malaria oased' on their personal knot-dodge of the applicant's wort: Work expedenoa or cinnamon-related qualifications are permitted.) . . - . 2. The fad ??31 the i023 applicant'woritediin a political campaign or beiang?jalapg??cai ma?a "to belting ooil?oai organization ora poii?oal party. I - . 3 The fact toot-the loo-applicant contributed atoney. raised drone-3.r or provided someming-etaa of talus to a political Organization. Or the iodine: the?j?oo applicant tint:t or poiiticai party. Or-thoiia'ot that major: applicanl'?tnsa not to work in a political campaign'or ._:chosa notto or raise money fora candidate for a political organisation?j? r. The facilitai thel applicant is a Democrat art-:3 Republican or other uncritical Orthe factilha't the applicant is not a member. 5 The fool that meatlpiicant expressed beliefs on riiatiorsia?um as val-lat oandiditosoreieded o?idaia he_or_ sholfiat?ored'or opposed. ma potato policy issue he or she favored or on government actions orzfailtrros to act-lea jgcertify that. I am aware of and em intuit corn-{alienation metabolic started prohibitions regarding personnel decisions by of chicago medial-as Maggi:on to me. I oemiy. under penalty oi perjury. as provided by law. that, to the best of thy knowledge-and after due inouirywpoiiticai reasons or factors?didnol enter mossy City employrn attractions taken with respect to the applicants in the hiring process for the above referenced, position. i understand that'faiiura with the above prohibitions andior failure'toratibmit an acwrate i-jiim Certi?cation Form may result in disciplinary action up to and including immediate tenninationa'nd may no to prosecution for penury'under Illinois law. Check the role(s) in the hiring process in which you participated, initial each checked box and sign at the bottom. Participated in Intake Session I I I Conducted, Monitored or Scored Test I Candidate Selected for Hire initiat Inmar (Circle function) 'n l-ai Screened Applicants I Hiring Manager Commissioner Inisai initial ii Ital Created Referral List I Facilitated Consensus Meeting I I Other: Initial initial inilial interviewed Candidate I Participated in Consensus Meeting lnloal Ini?al r?i ix- Juan Lopez i natur Print Name: Date: it as! Updated: 12/1/11 1 Revised 1i10!2012 Print Farm ill-tire Certification Forin? Candidate Name: (599 attached} Job Title: Firefighter (If known) 059?2014-023 7 Dept. A-Form Request ll: Title Code: 8 31 Hire Type: ?Non-Interview Elntewiew HStudent UVqunteer (Example: 033-2008-001) Mother CAREERS Requisition Dept. (Example: #143228) Political reasons or factors shall not play-a role in hiring. Political reasons or any of the following: - . Recommendations for, hiring, promotion or other employment terms of of?ce humor: or political party of?cials that are not based on personal knotliledge of thejob applicant's wont sitills. wont experience or otheriob-related quali?cations. {But such recommendations from public of?ce holders or political party of?cials that-are based on their personal knowledge of the applicant's wont skillr work experience or other lob-related quali?cations are milled)- - 2 'The fact that the job applicant worked in a political campaign? or belongs to a political organization, or political party. Or the fact that the job applicant moss not to won: in a political campaign or to belong to a political organization or a political party. . 3 The fact that the job applicant contributed money. raised manager-provided something elsew value to a candidate for public of?ce 'or a political organization.? Or the fact that the [ob applicant chose nettle oon?tnpute or" raise money for a candidate for public of?ce or a political organization. 4 ,51'he?fact that the applicant is a diam-tiara: or a Republican or-a member pl appzolher political party or group; Or the fact that the applicant is not a member.. 5 The fact that the applicant expressed views or beliefs on political niatters such as?what Candidates'or elected o?'lciels he or she favored or opposed-What public DOllC?l he 0? She lat-Hirer] 0? opposed. or What views on government actions or failures to act he or she expressed. I I certify that. am aware of and am in full compliance with the above stated prohibi?ons'regardh'lg personnel decisions byline City of Chicago insular as they apply to me. I certify. under penalty of parlor-y. as provided by law. that. to the best of my knowledge ano?alter'due inouiry. political reasons-?or factors did not enter into antr Cityemploymenl actionslalren with respect to the applicants in the hiring-prowess for the above referenced position. l'understahd thattailure to comply with the andlor'tailure?to submit an amate l-iire Certi?cationFonn may rasultin disolplinanr action up-?to and including immediate lamination and may subtract me to prosecution for poultry under Illinoiatlawr - . ,e Check the role(s) in the hiring process in which you participated, initial each checked box and sign at the bottom. Participated in Intake Session I i Conducted. Monitored or Scored Test Initial (Circle appropriate function) Candidate Selected for Hire Initial .IQJ Screened Applicants I I Hiring Manager initial Initial Created Referral List I Facilitated Consensus Meeting Initial Initial Interviewed Candidate I Participated in Consensus Meeting Initial Initial - Commissioner Initial Other: v?n ll?lulral Jose A Santiago Fire Commissioner 25: Date: Si nature: Print Name: Last titrated: tzmil' k/ Revised Ill @2012 Termination: Review Page 1 of 1 COC-HR Oper Dept Self Service Navigator ?3 Favorites Home Logout Preferences Help Termination: Review. I . . . Cancel i Bat}; Save For tateri Effective Date 21-May-2014 Employee Name Linea!Ir JUAN Employee Numb Manager SONYA Organization Email Address Department 059-4118 FIRE - Job SUPPRESSION AND RESCUE Review your changes and, if needed, attadh supporting documents. 0 Indicates Changed Items. Termination Details Termination Date 21-May-2014 Noti?cation Date 21?May-2o14 Reason Discharge Rehire Comments Additional Information Attachments To help approvers understand the request, you can attach supporting documents, images, or links to this action. None5 Add i Approvers DetailsiLine No Approver gApprover Type {Order No Category Status Delete 51w 1 EBRYANT, ADRIANNE People Approver may! Pidth Comments to Approyer Tilting] Save Fortath lav-v-15. - Home Logout Preferences Help Privacy Statement Copyright 2006, Oracle. All rights reserved. 5/23/2014 CHICAGO FIRE DEPARTMENT CITY OF CHICAGO May 22, 2014 Candidate Fire?ghter/EMT Juan Lopez File# 21159 You are hereby noti?ed that by orders of the Fire Commissioner you are discharged from the Chicago ire Department. Your discharge is pursuant to Section 9.1B of the Labor Agreement and you are discharged effective as of May 22, 2014. With respect to your medical and life insurance bene?ts, coverage will terminate on the effective date of your separation. You have the right to convert to individual coverage under the Public Health Service Act (attached). If you have any questions as to continuation on conversion of your bene?ts, contact the Bene?ts Service Of?ce at 377-299-5111. Paycheck(s) are to be picked up at the Personnel Division. .- - - (vi --rt (if Adrianne L. Bryant Deputy Commissioner Personnel Division cc: DFC Anthony Vasquez Administrative Services. DFC John cNicholas Operation ADFC William Boyle Operation/EMS Chief William Vogt, Acting Chief of Training Lieutenant Curtis Hudson EMS Training Labor Relations Assistant Commissioner Steve Malec IAD Local No. 2 File CHICAGO FIRE DEPARTMENT PERSONNEL ACTION Name Soc. Sec. File ?03 Job Title M95313 . Title Code 8731 Grade Badge Unit TRAINING Bureau OPERATIONS Plat, Daley 5 Cont. Serv. Date Ell/2914 Seniority Birth Date Sex Race Home Address Zip Home Phone Detail Date Detailed to Unit Bureau Marital Status Spouse's Name Employee's Previous Name TYPE OF ACTION: Effective 0300 HOUBE Hours on MAY 22. 2014 to SEE BELOW New Hire Transfer into Department Resignation Age and?se?ice Compulsory Retirement Reinstatement Death Promotion _lCharses)__ . Reinstatement to Career Service Rank Leave of Absence Dock in Pay Title Change Only Name Change Extension of Leave Other REMARKS SUSpension (Number of Calendar Days) CODE 60: DISCHARGED. EFFECTIVE MAY 22, 2014. ONLY. LAST DAY ON PAYROLL MAY 21, 2014. {For Suspension Only) Incident Date Wimend Approval [3 SuJJlliit9od x" - . (til 1.4- I. L) 43') Director of Personnel I Date Assist?ant Director Personnel CC: District Payroll Data Entry Hold File FD. #996 I 997 Rev (5l99l F. A leave of absence may be cancelled by the Fire Commissioner Upon evidence that the cause for its original authorization was fraudulent or has as a matter of fact ceased to exist. G. When a leave has been granted prOperly. and when the employee is prepared to return to work in conformance with the terms and conditions of this Article. the following shall apply: 1. An employee returning from a leave of three (3) months or less shall be fully restored to his or her position. 2. An employee returning from a leaVe of more than three (3) months shall be fully restored to his or her position, if available. or, if not available. the employee shall be restored to a position of equal rank. H. Any employee who is on a leave of absence from the Fire Department shall not be considered in the certification and appointment from promotional eligible lists. tion 8.3 - Family Medical Leave Act iloyees shall be entitled to leave without pay as provided in the Family iical LeaVe Act, provided that the employee has the option to elect to use ued paid leave to which the employee is entitled. and provided that health a benefits shall continue if the employee continues to make hislher health 2 contributions. IX. 8 tion 9.1 - Seniorit A. Seniority is defined as an employee's length of continuous service since his last date of hire. If more than one person is hired on the same day they shall be placed on the seniority list according to their rank on the eligibility list. /78. New employees will serve a probationary period of nine (9) months of - employment. Any inactive status during the probationary period shall not count toward completion of the probationary period, except that duty- related medical leave of a total of ten (10) working days or less shall not extend the probationary period. Any probationary employee may be discharged during the probationary period upon written notice (or verbal notice confirmed in writing) to the employee. A COpy of the notice showing the effective date oft termination shall be provided to the Union. . Terminations of probationary employees shall not be subject to the grievance procedure; however. upon the Union's request made within ten 39 {l0} days of notice of discharge to the employee and the Union, the employee and the Union may present evidence relating to the validity of the reasons or mitigating Circumstances to the Department at a meeting between the Department and the Union; but any action taken by the Department shall be final and shall not be subject to the grievance procedure. The seniority of the employee retained beyond the probationary period shall data back to his/her date of hire. it is further provided that for an additional three months of employment beyond the probationary period any new employee may be tested for substance abuse and if the test results are positive the employee may be terminated and such termination shall net be strb?terzt lo the grievance procedure. C. An employee's continuous service and the employment relationship shall be terminated when an emplOyee: 1. Resigns or quits with the following exceptions: a. An employee who resigned and was reinstated prior to March 8. 1980 shall retain the seniority date listed on the 1982 seniority list provided such date is not adjusted othenNise as provided or permitted in the Seniority Settlement Agreement of February 1. 1983. b. An employee who resigned in the past and was not reinstated until March a. 1980 or later. or who resigns in the future, shall have his seniority based on his last date of hire which shall be the day oi the return to service. unless he requests or requested reinstatement on or before thirty {30' days after the effective date at his resignation and such request is or was ultimately granted. in wllicl'l case he shall continue to use the seniority date in ellect prior to his resignation provided such date Is not acllusted otherwise provided or permitted in the Seniority Settlement Agreemet of February 1. 1933. 2 is discharged for just cause; 3. Retires or is retired; 4. Is absent for three (3) consecutive days (workdays) without notifying the Employer?s authorized representative; 5. Is laid off and fails to report for work within ten (10) calendar days after mailing by certified mail a notification of recall to the employee's last known address as shown on the City's personne records. A copy oi recall notification shall be sent to the Union. 40 CHICAGO FIRE DEPARTMENT PERSONNEL DIVISION SEPARATIQN EQEM DATE: May 22, 2014 DISTRICT: CANDIDATE ASSIGNMENT: PAYROLL: 401-151)? NAME LOPEZ, JUAN RANK FIREFIGHFER onee BADGE ??ber FILE 21159 FURLOUGII EARNED 2012 PAYABLE ZQIB FURLOUGII EARNED 2013 PAYABLE FURLOUGI-I EARNED (CURRENT STRATIVE DAYS 20 YEARS PLUS SERVICE FURLOUGH - 25 YEARS PLUS SERVICE FURIIOUGH OTAL PAYABLE, 8 HOUR DAYS 1/3 AVAILABILITY PA PER QUARTER PAYABLE 8 HOUR DAYS PAYABLE 8 HOUR DAYS PAYABLE 8 HOUR DAYS PAYAB LE 8 HOUR DAYS PAYABLE 3 HOUR DAYS PAYABLE 8 HOUR DAYS 2/3 FULL FOR UNUSED FUR TO BE DETERMINED AS PER SECTION 7.1C OF THE LABOR YES NO DATE LAID UP REMOVAL DATE _M.jy2_2, 2014 COMMENTS: CNIISELISQAQISS CONTINUOUS SERVICE DATE: 3117120I4 FURLOUGII: 2013 2014 L-f: ?1 l; I Division LAST DAY WORKED 5116;2911 PHONE II .1 Department of Human Resources COMPLETE ONLY IF EMPLOYEE IS LEAVING CITY SERVICE Name (Print) JUAN Employee Number LOPEZ, May 22. 2014 End of Employment Date FIREFIGHTER #8_7_31 Title Code Number Department Payroll Number male I gods I 3l1 712014 5/16/2014 5121:0014 Start Date Last Day Last Day on With City Worked Payroll Salary at time of separation (Year) 3 50.490.00 Vacation Pay after Last Day Worked, if any Thru Tuition Reimbursement? Yes. If yes, contact DHR a Finance Administration division. From 5-4210 Telephone Number DFC John McNicholas Name of Immediate Supervisor CITY OF CHICAGO End of Employment Form PrintForm DATE May 22, 2014 I*Reason for Leaving (Check most appropriate reason) 01 Other employment 06 Retirement 11 Working Conditions 02 AWOL 07 Marriage 12?Promotional Opportunity 03 Family Responsibilities 08 Maternity 13 Compensation 04 Return to School 09 Relocation 14 Hours 05 Military service 10 Supervision 15 Leave of Absence-Personal 16 No reason given 1? Resignation 18 Termination for Cause Other Dischargg *ltems received from employee {please initial) Keys Pager Lap-Top. PDA Cell Phone Blackberry City ID. Card External Memory (?ash drive) Security Card Current address and phone? Yes No If no, complete Change of Address Form and send it to DHR Rl MS division *Additional comments required Code 60: Discharoe 1" J. Preparer's Signature ?WerZ- Employee Signature *Departments MUST submit supporting documentation to DHR Title Phone Number 6?6920 Date Revised on 6f25l2010 PER 78 CITY OF CHICAGO DEPARTMENT OF HUMAN RESOURCES PERSONNEL FILE PART II HIRING PAPERWORK CHECKLIST Name of Selected Candi-date: .. .- . Department: 3 - . . Joli Title: "it: till? Cwnci! - It?: - I mus: N.UIERMANIIL . . "dept CAREERS Requit?it?i?h?rr i l. I. . .If.h-Jl_ REQUIREQ: .CempletqSelf-:Seryiee an email from Dill?'elnferina'llon ?elr?lce-Divielonl . Candidate Selected for Residency Affidavit Hire Certification Form (New Hires Only} (New Hires . {New and CurrentHires) Commitment to Follow the City of Ethice Pledge Chicago's Code of Conduct BACKGROUND DISCLOSURE RELEASE FORM ETIEERED YES NO (New Hires 8. Recalls/Rehires a ver 90 Days) "x EEO Policy Acknowledgement (1)08 (2)Provisional Ordinance (6)Exempl Program (7)Emergency (8)Exempt Confidential (9)Exempt Seasonal I Pre-Emploi?ent Check Education Reference __??llndebtedness Criminal Background MT Recruiter Effective Date: Initials FINAL Date 55/1201? Initials NO Date Initials Mom?I I - r-1 'N?thu? "Imn?lmhmA-A?? ?ln if PLEASE RETURN THIS FORM ALONG WITH THE REQUIRED PAPERWORK TO: DEPARTMENT OF HUMAN RESOURCES 1 Employment Services 121 North LaSalle Street Room 1100 Chicado. Illinois 60602 .IWI?I?ume-v?ua? D-um I'me Hunt-t? . 03/25/2015 to Fgllovv the City of Chicago?s Cody of Conduct As a condition and in consideration of my employment by the City of Chicago. I hereby commit myself to follow the City's Code of Conduct, pursuant to ?2-156-005 of the Municipal Code of Chicago: The code of conduct set forth in this section shall be aspirational and shall guide the conduct of every of?cial and employee of the City. As an employee of the City. i shall: (1) remember that i am a public servant who must place loyalty to the federal and Illinois constitutions. laws. and ethical principles above my private gain or interest. (2) give a full day's work fora full day's pay. (3) put forth honest effort in the performance of my duties. (4) treat members of the public with respect and be responsive and forthcoming in meeting their requests for information. (5) act impartially in the performance of my duties. so that no private organization or individual is given preferential treatment. (6) refrain from making any unauthorized promises purporting to bind the City. (7) nevar use any nonpublic information obtained through the performance of City work for private gain. (8) engage in no business or financial transaction with any individual. organization or business that is inconsistent with the performance of my City duties. (9) protect and conserve City prOperIy and resources, and use City property and resources only for authorized purposes or activities. (10) disclose waste. fraud. abuse. and corruption to the appropriate authorities. (11) adhere to all applicable laws and regulations that provide equal opportunity for all persons regardless of race. color. religion. gender. national origin. age. sexual orientation. or handicap. i understand that this document is not Intended to. and does not, create any right or benefit. substantive or procedural. enforCeable at law or equity. by any party against the City. its departments. agencies. entitles. Ogle?; employees regents. or any other person. . .. . /z Mart p-at? til?r??th??f Jars-2. Printed Name ?Mi/ii . Form ETHICS PLEDGE PURSUANT TO 52-156-105 OF THE GOVERNMENTAL ETHICS ORDINANCE its a condition. and in omelet-notion. of my employment or appointn-n-rnl by the City of {litica?O in a position invested with the public trust. I strait, upon leaving government employment or with the applicable requirements of Section 2456?105? of the Chicago Municipal tinde- inrposing restrictions upon lobbying by former government employer-ts, whinh I understand are binding on me and are enforceable under law. acknowledge that Section 2456-105" of the Chicago Municipal Code. which i have read before signing this pledge. imposes restrictions upon former government employees and appointees and sets forth the methods for enforcing them. i expressly accept the applicable provisions of Section 24 55-105" of the Chicago Municipal Code as part of this agreement and as binding on me. i understand that the terms of this pledge are in addition to any statutory or other legal restrictions applicable to me by virtuo of government service. 2456-105. Post-employment Restrictions on Lobbying. Any person who serves as a non