UNCG FACULTY & EPA PERSONNEL ACTION FORM PD7

Use this button to submit and print this form -->
Fields marked * are required for submission Date April 19, 2024

UNCG ID

Name Prefix Last Name* Suffix First name Middle Name
The person's name must be entered exactly as it appears on their Social Security Card.

Payroll Address Line1

Line2

City State Zip

Country

Office Location Building Room # Phone

Employee Information Benefits Earning Student Teaching Position

AAO Forms Complete Date AAO Forms Approved (mm/dd/yyyy)

Citizenship Visa Type If not US Citizen Visa Expiration Date (mm/dd/yyyy)

Credentials Verified

Employee E-Class

Part or Full Time Status

Home Org* (numeric code)

Check Dist. Org* (numeric code)

Dept. of Academic Rank

First Work Date Last Work Date

This is a Graduate Assistant.

I-9 Checks Employee has worked at UNCG within the past 12 months

Employee is a retiree returning to a temp position

Background Checks

Checks requested in addition to required criminal/sexual offender background check

Credit History check Driving History check

Comments (484 characters maximum.)

Early Job Termination Used when employee has a current job termination date on Banner HR.

Date to Terminate Current Job (mm/dd/yyyy)

Position Number

Job Change Reason

Reason for early termination of job

New Job Action Posn # Suffix FTE

	Index	Fund	Orgn.	Account	Program	Annual Salary	Percent
TOTALS						$
1.						$
2.						$
3.						$
4.						$
5.						$
6.						$
7.						$
8.						$
9.						$
10.						$

Plus Salary Increase

Appointment Action NEW APPOINTMENT PROMOTION CHANGE IN RANK

Effective Date (mm/dd/yyyy) Personnel Date (mm/dd/yyyy)

Factors and Pays

Timesheet Org (numeric code)

Title

EPA Nonfaculty annual leave allowance recommended (if appropriate) days

Replacement for faculty on research assignment/leave (Name)

Assignment Type RESEARCH ASSIGNMENT OFF CAMPUS ASSIGNMENT

Leave of Absence - Leave Reason

Full Pay Partial Pay Without Pay

Purpose of assignment

Beginning Date (mm/dd/yyyy) Ending Date (mm/dd/yyyy)

Job/Employee Termination Note Except for retirees no vacation or bonus leave may be taken after last work date.

Last Paid Date (mm/dd/yyyy)

Terminate Employee Termination Reason

Rank at Time of Separation

Job Change Reason

Reason for resignation

Name ChangeAttach copy of new Social Security card for name changes. Do not use for Graduate Assistants.

Enter Employee's Previous Name

Prefix Last Name Suffix First Name Middle Name

Use this button to submit and print this form -->