Compensation and Benefits
1901 Herbert Spaugh Lane
Charlotte, North Carolina 28208
Verification of Eligible North Carolina State Employment
Please read instructions on following page before filling out this form
Part I: Employee information (Must be completed by Employee)
_____________________________________________________
Last
First
_______-______-_______
Maiden or Middle
________________________________________
Social Security Number
________________
_______
_________
Street Address
City
State
Zip Code
I was employed with __________________________________________________________________________
Previous Employer
as a __________________________________________ from ___________________ to ____________________.
Job Title
Begin Date
End Date
Part II: Confirmation of Employment (Must be completed by Previous Employer)
1. Employment Information:
Dates of Employment
Begin Date
End Date
Employment Status
Part Time Full Time
NC Retirement
Contribution
Yes
No
2. Total Eligible NC State Service: ________________ Years
Dates of Leave
Without Pay
Begin Date
End Date
________________ Months
 Yes
3. Was a longevity check issued when employee left your organization?
a. If yes, was it a:
 Full Check OR
 Partial Check
 No
b. If partial check, please indicate the fraction of a full check. _______ Amount of Check? _______
c. What is the employee’s longevity date? ______________________
4. Leave Balances in Hours:
Annual Leave Hours
as of
Sick Leave Hours
as of
Personal Leave Hours
as of
5. Contact Information:
Completed By: ______________________________
Title: _________________________
School System / State Agency: _________________________________________________
Address: __________________________________________________________________
Phone Number: (_____)______-________ x _____ Fax Number: (_____)______-_______
Authorized Signature: ___________________________________ Date: _______________
NOTE: Please fax or mail this completed form directly to Charlotte-Mecklenburg Schools.
Phone: 980-343-1847
Fax: 980-343-3165
www.cms.k12.nc.us
mycompensation@cms.k12.nc.us
Explanation and instructions for Verification of Eligible NC State
Employment form.
The Verification of Eligible NC State Employment form allows for the transfer of permanent part and/or
permanent full time service (for NC State longevity purposes) and leave accruals from other NC school
districts or NC State Agencies as outlined in the NC DPI Benefits and Employment Policy Manual.
NC does not allow for the transfer of leave accruals or service time from other states or countries.
It is each employee’s responsibility to procure verification of prior NC state service and/or the transfer of
leave accruals and submit it through the Compensation Department (980)343-1847.
Total state service time affects the rate at which you earn annual leave as well as the rate you will be paid
longevity once you have completed a total of 10 years of eligible North Carolina state service.
It does NOT, however, affect the years of experience on an educator’s license. An employee’s salary
schedule step may not equal the number of state service years.
If you have prior NC state service, you must:
1. Complete Part I of the Verification of Eligible North Carolina State Employment form and send it
to your previous state employer.
a. If there are multiple previous state employers, make copies of the blank form first. Then,
complete a form for each previous state employer and send them to the corresponding
state employer.
2. Your previous employer(s) should complete Part II of the form and submit it directly to
Charlotte-Mecklenburg Schools by mailing it to the address listed below, by scanning it to the
email address listed below or by faxing it to the fax number listed below.
scanned to: mycompensation@cms.k12.nc.us
faxed to (980)343-3165
Mailed to: Compensation Department
Charlotte-Mecklenburg Schools
1901 Herbert Spaugh Lane
Charlotte, NC 29208
Questions should be directed to (980)343-1847 or by email to mycompensation@cms.k12.nc.us
Phone: 980-343-1847
Fax: 980-343-3165
www.cms.k12.nc.us
mycompensation@cms.k12.nc.us