DEPARTMENT OF COMMUNITY COLLEGES
RESEARCH AND INFORMATION DIVISION
MANAGEMENT INFORMATION SERVICES
200 West Jones Street
Raleigh, NC 27603-1337
(919) 733-7051
PITT COMMUNITY COLLEGE
INSTITUTIONAL STAFF INFORMATION DATA
Instructions: Complete this form at the time of employment of new employees and submit data and code sheets
to Human Resources (VEW-1A). Print or type all entries. On multiple selection items, enter the most appropriate
number.
It is essential to collect data and make changes in the NCCCS database as they occur for all staff/faculty.
For changes enter name, social security number, and appropriate changes below.
Last Name: _____________________________
First Name and Middle Initial:
________________________________________
Social Security Number: __________________________
Date Employed: ________________________________
Job Title: _______________________________________
Supervisor: _______________________________________
Sex:
1 - Male , 2 - Female
Academic Level:
01 Less Than High School
02 High School or Equivalent
03 One Year of College
04 Vocational Diploma
05 Two Years of College
06 Associates Degree
07 Three-Four Years of College
08 Bachelor’s Degree
09 Master’s Degree
10 Doctor’s Degree
11 Educational Specialist
Date Attained: ___________________
Race:
1 White--Non-Hispanic
2 Black--Non-Hispanic
3 American Indian or Alaskan Native
4 Hispanic or Spanish Culture
5 Asian or Pacific Islands
6 Other
Action Code:
New Employee
Employment Classification:
1 – Full-Time Regular
3 – Full-Time Other (NC Retirement System
participant working 30-39 hrs/wk)
4 – Part-Time
Are you a PCC Student? _________
OCR Code :
Change Status
Disability (enter applicable code 1 – 9):
1 – Emotional (Psych) Impairment
2 – Hearing Impairment
3 – Learning Impairment
4 – Mental Impairment
5 – Orthopedic Impairment
6 – Speech Impairment
7 – Visual Impairment
8 – Other Health Impairment
9 – No Disability
Non Resident Alien:
1-Yes
1 – Executive/Administrative/Managerial
2 – Instructional (Faculty)
3 – Professional
4 – Clerical
5 – Technical/Paraprofessional
6 – Skilled Crafts
7 – Service/Maintenance
Area of Responsibility:
From Code Sheet A, select the code representing the
Principal Area of Responsibility.
Area of Instruction:
2-No
Months of Employment:____________________
(Enter # months this position is normally employed in a
12-month Fiscal year.)
From Code Sheet B, select the code representing the
Principal Area of Instruction.
Subjects Taught:________________________
_______________________________________