EPA Perm
East Carolina University - ONE FORM
EPA Temp
SPA Perm
2
Department/Section
Description of This Action
Action Code
SECTION TWO: EMPLOYEE INFORMATION
3
FROM Last Name
First Name
TO
Last Name (Name Change Only)
5
Mailing Address (Local)
City
6
Employee Classification/Title/Rank
Job Class
7
15 Digit Position Number / 5 digit
6065-00 /
Apptmt Type
First Name
Middle
Appt Term
Hrs per Wk
FLSA
County
Race
HC
Date Prepared
Effective Date
ALSO COMPLETE SECTION ONE AND FIVE
Middle
Banner ID
4
8
SPA Temp (CHECK ONE) Rev. 03/22/01
SPA TLP
SECTION ONE : DEPARTMENT INFORMATION COMPLETE FOR ALL ACTIONS
1
Division
School
Mail Stop #
Vet
EducCode
Ending Date(Grant/Tmp)
Sex
Date of Birth
Degree (Abr)
Citizenship
State
Grade
# Installments
Permanently Tenured
Permanent (Non tenure track)
Step
Visa
Zip Code
Appt Value/FTE
EPA Contract Period:
Date Begins:
Job Department #
Date Ends:
Temporary
Part-time
Probationary
Employee Salary
$
9
Work Schedule:
ATTACH COPY
Fixed (Not subject to change)
Irregular or Rotations – Explain:
Type of License/Certificate:
Monday-Friday 8AM to 5PM
Other – Please Identify:
License/Certificate # :
Exp. Date:
SECTION THREE: SEPARATION INFORMATION ALSO COMPLETE SECTION ONE AND FIVE - Plus required info in Section Two (Attach Leave Card)
10
Reason Code
Date of Death
Hrs Paid Term
Reason for Separation
Last Eval Rating
11
Last Work Date:
Separation Date:
12
Holiday(s) Observed:
Hrs:
Hrs:
Hrs Sck Leave Exhausted:
Hrs Vac Leave Exhausted:
From:
From:
/
/
To:
To:
/
/
Sck Leave Bal:
Vac Leave Bal:
Comp Leave Used:
SECTION FOUR: POSITION INFORMATION
13
From Job Department #
14
Position Classification or Title Requested
ALSO COMPLETE SECTIONS ONE AND FIVE (ALSO COMPLETE SECTION TWO IF OCCUPIED)
To Job Department #
From Position Number (15 digit/5 digit)
To Position Number (15 digit/5digit)
6065-00 /
6065-00 /
15
Job Class
Grade
Budget Amt Per Account Line (Put in same order as in Section 5)
Pos Type
FLSA
Hrs/Wk
Mos/Yr
Mgr/Sup
1 $
3 $
2 $
4 $
16
Immediate Supervisor and Title
Supervisor Pos.# Pending Increase
Add/Delete
$
Exp. Date:
SECTION FIVE: FUNDING INFORMATION COMPLETE FOR ALL ACTIONS
FROM
TO

Position
Number
Purpose
Budget
Code
Code

FRS
Account
Object
%
FTE
Semi-monthly
Distr. Amount
Employee
Annual
Salary
Position
Number
TOTAL FTE & SEMI-MONTH DISTR. AMOUNT
If from more than one source
Budget
Code
Purpose
Code
Object
FRS
Account
%
FTE
Semi-monthly
Distr. Amount
Employee
Annual
Salary
TOTAL FTE & SEMI-MONTH DISTR. AMOUNT
If from more than one source
SECTION SIX: BUDGET INFORMATION AND SALARY RESERVE CHANGE
Transfer Funds/Reserve
Previously employed:
Semester:
Perm
Temp
From #
To #
$
Others that occupy position:
Perm
Temp
From #
To #
$
Last occupant of position:
Perm
Temp
From #
To #
$
Position borrowed from:
Source of Other Funds:
Currently in position (other than above): #
SECTION SEVEN: ADDITIONAL INFORMATION
Mailed
Pick-up Box
Faxed
HD
Accepted
Rejected
Budget
Revision
Number
Year:
Department:
Date processed:
Degree Hegis (Area)
PCS Hegis
SECTION EIGHT: PERSONNEL, BUDGET COMMENTS or INTERAGENCY TRANSFER INFORMATION
SECTION NINE: APPROVAL PROCESS – Sign and Date
Department/Section
Date
Division Approval
/
School/Deans Office
/
Date
Grants Admin/Special Funds
/
Date
Budget Office
Date
/
Date
Employment
Class & Comp
Date
EEO Vacancy #
IPS
/
EEO Office
/