Federal personnel manual system

MISSING IMAGE

Material Information

Title:
Federal personnel manual system
Portion of title:
FPM letter
Physical Description:
Book
Language:
English
Creator:
United States Civil Service Commission
United States -- Office of Personnel Management
Publisher:
United States Civil Service Commission
Place of Publication:
Washington, D.C
Frequency:
irregular
completely irregular

Subjects

Subjects / Keywords:
Personnel management -- Handbooks, manuals, etc -- United States   ( nal )
Civil service -- Handbooks, manuals, etc -- United States   ( lcsh )
Personnel management -- Handbooks, manuals, etc -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
periodical   ( marcgt )

Notes

Issuing Body:
Vols for 1979- issued by: Office of Personnel Management.
General Note:
Description based on: 410-19 (Aug. 22, 1977); title from caption.
General Note:
Latest issue consutled: 292-23 (No. 3, 1983); title from caption.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 021549616
oclc - 06727309
lccn - 2009238041
System ID:
AA00012996:00023


This item is only available as the following downloads:


Full Text



riueuiiiu r ann e. avuianuuo 37S5em


gUICZ pie Stan4sd Formas50 and 52, aad Introd uctio ,
.i: ",,, A Astopate4 7 S 0-:


: eads. departments and independent Establishments:



!a" .4 be s..ii...:.:tawrd forms are. revrise4.:..

S 50, NIobttication of Personnel Action.
SF 5--3 Reqspt: for Personnpl Action

f 0o-, iotification of Personnel Action, ts a new automate
Is. being introduced for use by agencies with automated systems.

e:...aimilies of the forms are attached.

IEAIja ON TO PREVIOUS PROPOSALS TO REVISE THESE FORMS


Published in advance
of incorporation in FPM
Chapters 2% and
EI~ UNTIm SU2RS5EDE


ton, D. C. 20415
July 28, 1980









50 which


Lettn 296-30, "Proposed. Revision of FPM Supplement 296-31, Guide to Processing
gl Actions," referred to toye isns of. SF 50 and.SF 52 planned for implementation
..ppposed revised Supplements. The modifications being made in SF 50 and SF 52
.i.me are. not those anticipated revisions.

ti Fat few years, there have been proposals for substantive changes to the
ie asm the addition of. Faith, Labor Standards At coverage or male/female designations
i; M.I*. "' rs,.," 3 I.,'. 4~ "Mss. designationes. At the time these were being
. It: ws l wnp ~.thEat ajgrchanges would occur with the final revision of Supple-
i-I. i. oe tesr than iiapose tqprqgramming..efforts for substantive SF 50 changes now
In. ~it the implementation of the revised Supplemept, we have decided to continue
fs gpisr4k the basic (ormat that now exists and delay all substantive changes until
tbd supplementt is put into effect.


AVunsVE V.R=IOnS

Thaeesverioas of SF 50 (including
now : viable in: order to meet the
wll difi r only with respect to:
addit1io6a W Item 30, Remarks (all


the new automated version referred to as SF 50-B) are
needs of both automated and manual systems. The forms
Item 8, Handicap Code; the construction; and the
discussed below).


The ST 50- 5-ply continuous feed version for automated systems, is available for the
irst time. Te forifh ply SF: S0-B is. designated as the OPM/Utility Copy. Most agencies
ia hi toseC thi~~ tr.uti iir1 .imake submissions, to the Central Personnel Data File (CPDF)
via magnAe1tc.g:: tI # cardA rather than hard copy. Therefore, only agencies which complete
the S ?50 p9o automatic typewiters should need this copy for CPDF submissions. Please note
that in 'ACi e..spe ,.ta han icap code must be typed in Item 30, Remarks, as Item 8, Handi-
cap C04 U6i :boked...-p on all, copies of the SF 50-B. All automated agencies may use
the fourth ply as a utility copy.


Agency Relattons (ACE), Work Force Information Division, Records Management
quiri Branch, ( I2) 254-9793, -9899
Cod... 296, te:raciSt I 0 r nel 'Actions
ODiMtribut :. M 5

OPM FORM 652 1/79
































structions and include: I .

1. The addition on all forms of the designation "fs." to item 1. '
2. The addition on all forms of code 6 to Item 5, Veteran Preference.
3. The identification on all forms of Service Computation Date for Leave In-ait 'IS
day-year sequence in Item 7.
4. The blocking out of Item 8, Handicap Code, on all copies of the manuaill.y-p b"
SF 50 except the OPM copy; the blocking out of the item on all copies of the "
continuous feed SF 50-B; and the deletion of .the item from SF 52. :
5. The addition on all forms of codes 3-8 to Item 28, Position Occupied.
6. The deletion on all forms of apportioned position data from Item 29.
7. The addition of information on the Senior Executive Service to the revetrse
of the employee copy of all versions of SF 50.
8. The inclusion of the following in Item 30, Remarks, on the manually-prepared
SF 50 and SF 52.

a. Supervisory/Managerial Indicator
b. Work Schedule
c. Pay Rate Determinant
d. Special Program Id
e. Education Level
f. Year Degree Attained .
g. Academic Discipline

These items will not be printed on the SF 50-B at this time due to the re- :
programming implications this would have for automated systems. Agencies which ':"
make automated submissions to CPDF continue to have the option of including or 7
omitting these items from the personnel action document. .
9. Change in the employee instruction for stating reason for resignation on SF 52.
10. The inclusion on SF 52 of a certification statement to be signed by the approving :.:.
official. :
11. The rearrangement of some items on SF 52 to improve design.
12. Change in references from CSC to OFM.
13. Prepunched holes on bottom of SF 52.
14. The addition of an employee instruction to complete Part IV of SF 52.
15. The addition of "SON" (Submitting Office Number) to item 35 on SF 50.
16. The addition on all forms of code 6 to Item 10, Retirement, to record coverage under:
Civil Service Retirement which is subject to 7 112 percent salary deductions for
applicable firefighter and law enforcement positions.





FPM LTR. No. 296-76 (3)


CONSTRUCTION
SF 50 is now printed in two different constructions: 5- and 6-part carbon interleaved
snapout sets for use in manual systems. SF 50-B is printed as a 5-part carbon inter-
leaved continuous pinfeed version for use in automated systems. The order of the parts
is:

SF 50 SF 50 SF 50-B
5-Part Snapout 6-Part Snapout 5-Part Continuous

Part 1 Employee Copy Employee Copy Employee Copy
Part 2 Payroll Copy Payroll Copy Payroll Copy
Part 3 Personnel Folder Copy Personnel Folder Copy Personnel Folder Copy
Part 4 OPM Copy OPM Copy OPM/Utility Copy
Part 5 Chronological File Copy Chronological File Copy Chronological File Copy
Part 6 (None) Utility Copy (None)

EXCEPTION REQUESTS

Many automated agencies have current exceptions to SF 50 (12/61 edition), which were
obtained for the sole purpose of printing marginally-punched continuous construction
of the form. Agencies with this exception will begin using SF 50-B when supplies of
their own form are depleted. (Please note that overprinting of a standard form does
not require exception approval.)

Agencies with exceptions other than the above may continue using their approved forms
until stock is depleted. However, before these exception forms are reprinted, agencies
must revise their form to incorporate the changes on the 1980 edition of SF 50 or
SF 50-B and submit a new exception request in accordance with FPMR 101-11.806.1.

References made in FPM Chapter 290,3-2(c), which allowed agencies to modify SF 50 in
accordance with their ADP systems requirements without prior approval, are now obsolete.
Agencies which followed these instructions and did not obtain approval for their modifi-
cations will begin using the new automated version of SF 50-B when supplies of their forms
are depleted or they must submit an exception request.

ORDERING FORMS

SF 50-B will be available from the Federal Supply Service, General Services Administration
(GSA) by October 1, 1980. GSA will issue the previous editions of SF 50 (12/61) and SF 52
(7/68) until their stock is exhausted. Agencies will not receive the new editions until
all stock is depleted. They may be ordered by using the FEDSTRIP/MILSTRIP requisitioning
procedures. Please check the current GSA price listing as the cost of forms purchased
from GSA fluctuates frequently.
















SF 50
5-part snapout

SF 50
6-part snapout

SF 50-B
5-part continuous

SF 52


Ordering Information

National Stock No. Unit of Issue

7540-00-543-7078 RD


7540-00-823-7930 RD


7540-01-094-0034 Box (500)


7540-00-634-4004 HD


Std. Pack :.

4 HD
... ... :..:::....

10 HD
::'.. .. .. .



E ': :i
i '3














"ii





: .E


Jule tI. Sugarman
Deputy Director


Attachments







Slandaud Form 50
Revised March 1980
U.S. Office of Personnel Management
PPM Chapter 296


Attachment to FPM Ltr 296- 76
Page 1 of 21
Notification of Personnel Action
(Employee-See General Information On Revere)


(For Agency Use)

1. Name (Ceap) Lait-PlFlt-Mlddle IM.-Mlt-Mrs.-Ms. 2. (For Agency Use) 3. Birth Date 4. Socal Security No.
(Month. Day, Year)


5. Veteran Preference 6. Tenure Group 7. Service Come. Date Leve
I 1-No 3.10 Pt. DiMb. 5-10 Pt. Other (Month, Day. YVr)
2-5 Pt. 4-10 Pt. Comp. 6-10 P./30% Comp. ___
9. FEGLI 10. Retirement 11. Leave Blnk
1-Covered (Regular Only-Declined Optional) -- 1-CS 3-F5 S-Oher
2-Inolliable 3Walved 4-Covered (Ra. end Opt.) 2-FICA 4-None 6-CS Special
12. Nature of Action 13. Effective Date 14. Civil Service or Other Legal Authority
Code (Month, Day. Year)


1I. From: Position Title and Number 16. Pay Plan and 17.(a) Grade (b) Step 18. Salary
Occupational or or
Code Level Rate


i3. Name and Location of Employing Office





20. Toi Position Title and Number 21. Pay Pla 22.(a) Grade (b) Step 23. Salary
Occu al or or
Code Level Rate


24. Name and Location of Employing Office





25. Duty Station (City-County-State) 26. Location Code

27. Appropriation Position Occupied 29. Leave
1.5.6-Compceltlve Service 3-SES General
2.7.8-Encepted Service 4-SES Career Reserved


30. Remarks: A. Subject to completed t ionary (or trial) period commencing:
S. Service count' tower an for permanent) tenure from:
C Cheek, if en i betion I
bprraetlo: Show reeons below,


Su Mgr. indicator Work Schedule Pay Rate Determ. Special Prog. .D. Educational Level YVr. Degree Attained Academic Disciplne


31. Date of Appointment Affidavit (Accessions Only) (Mo., Day, Year) 34. Signature (or Other Authentication) and Title

M. Office Maintaining Personnel Folder (If Different from Employing
Office)

33. Code Employing Department or Agency
35. Date and SON


6 Part
50-136


Previous Edition Usable
NSN-7540-00-823-7930


1 Employe Copy






Attachment to FPM Ltr. 296-76
Page 2 of 21


NOTICE TO EMPLOYEE


KEEP THIS DOCUMENT FOR YOUR RECORDS. IT IS YOUR COPY OF THE OFFICIAL RECORD OF PERSONNEL
ACTION AFFECTING YOUR EMPLOYMENT. PROMPTLY CALL ANY ERROR TO THE
ATTENTION OF YOUR SUPERVISOR OR YOUR PERSONNEL OFFICE.


I. Conditions Pertinent To All Types of Personnel Actions
The personnel action identified on the face of this form is
subject to all applicable laws, rules and regulations governing
Federal employment and may be subject to investigation and
approval by the U.S. Office of Personnel Management. The action
may be corrected or canceled if not in accordance with all legal
requirements, or if based upon your misrepresentation or fraud.
In addition, the grade of the position to which you are
officially assigned may be reviewed and corrected by your agency
personnel office, or by the U.S. Office of Personnel Management.
Items 9 and 10 show common types of payroll deductions:
"FEGLI" for Federal Employees Group Life Insurance, "CS" for
Civil Service Retirement, "FICA" for Social Security, and "FS" for
Foreign Service. Additional deductions may be made under the
Federal Employees Health Benefits Program, and for income taxes,
bonds, and other purposes authorized by law.

II. Information About Appointments
Appointments to positions in the competitive service: The Civil
Service Act places most positions in the "competitive service." The
U.S. Office of Personnel Management sets qualification require-
ments and controls recruitment for such positions. As a general rule,
persons selected from civil service registers to fill continuing jobs in
the competitive service are given career-conditional appointments.
Such appointments are secured through direct competition with
other members of the general public seeking similar work in
Government agencies, and permit qualified employees to be assigned
without further competitive examination to other jobs in
competitive service. Career-conditional appointments become ca
appointments upon completion of 3 years of substantially coad
ous creditable service.
The first year following a contemporary competitive
ment generally is a probationary period during which an a
must demonstrate full competence and fitness for F eral V
ment. Reinstatements are also subject to a pro
unless one was previously completed. Transfer
changes to lower grade, and reassignments during a ion
period are subject to completion of probation
Temporary appointments do not co ice atus
and do not lead to a career or career io tment
without some further examination or ualifi 'Bited tempo-
rary appointments are made when _*is no iing need for a
person's service, regardless of the ann h he or she
qualified for appointment: accept s .tment will not
remove a person's name from a civil e re fr on which he or
she may later be reached for career-conditio i ointment.
Appointments to positions in the excepted service. Excepted
appointments are made to positions which are excepted from the
competitive service by law or other special authority. Generally the
employing agency sets qualification requirements and conducts
recruitment for such positions. Such appointments do not confer a
competitive civil service status or eligibility for movement to jobs in
the competitive service; they may be made without restrictions on
tenure, with a conditional or indefinite limitation, or with a definite
time limitation. A trial period may be required at the discretion of
the employing office.
Appointment to positions in the Senior Executive Service
(SESI. SES appointments are made to executive positions with
managerial, supervisory, or policy functions. Initial SES career
appointments are obtained through competition with other civil
service employees, or civil service employees and members of the
general public. The first year of an initial SES career appointment is
a probationary period, during which the appointee must demon-
strate full competence and fitness for such employment.
SES noncareer and limited appointments do not confer
competitive civil service status or lead to SES career appointments.


III. Information About Tmnunr Group
Employees are ranked in tenure groups according to thel "'iatni"i
of their appointment: those with unrestricted tenure amce f .il& ij
Group 1; those serving under conditional lppointrMentwsI. f,.. A
automatically lead to full tenure after a prescribed time i sfd'ii
further qualification are placed in Group 2; and those serqil 'w.. "'llt
temporary or indefinite appointments not limited t ma liI .,,;i
or date are placed in Group 3. Within each tenure group, w1 fI.it ll
determined by veteran preference, performance rating, ab il
Federal service. If it should become necessary to reduce :ii::"l JIII
employees are selected for separation or change to lower ii.iili
according to the general ranking. Employees serving under i f l!
tive appointments and those serving under excepted appoinim 0:u b .
are ranked separately for reduction in force purposes.
Tenure group as used for reduction in force purposes da qpiiiI
apply to the Senior Executive Service. Codes 4, 5. 6, 7. l8, l i
denote a type of appointment in the Senior Executive g iiii v ,;,;i
do not indicate tenure group. The codes mean:
4-SES career appointment-probation completed. .
5-SES career appointment-serving probation with pnlasm:..n;M
rights in another service. i---
^SES career appointment-serving probation without pla:. ''i
me rights in another service. : :
j .-S-Fioncareer appointment.
linmLt term appointment.. I
^JSlij'd emergency appointment.
-

Info ion About Your Stat After Saplrtion : ,,
-. i ware separated or placed in a nonpay status for A i: :
xten period, your employing agncy will furnish you. wnliiii
SStandard Form 8 explaining your rights for unemployment iil; :.:i; S
,nce benefits. If you were covered by the Civil Service Relirein :'i
stem or Federal Employees Group Life Insurance, you h ..:::::i
previously been furnished certificates describing thlaw pra igl i
FSuch certificates have information regarding your rights and po "iW J
benefits after separation.

It you are separated from a career or cereerconditiona'.,:
appointment, you may have reinstatement eligibility and may apply i"ij'
directly to any Federal activity and may be employed without
further competitive examination. If you are a nonvetrthi an)dr, J
are separated from a career-conditional appointment your eligibiity
for reinstatement is generally limited to 3 years from the dlli at
separation. If you are separated from a temporary or excepted
appointment, you have no reinstatement privileges based upon asch
service.
If you are separated from an SES career appointment, you mlay
have reinstatement eligibility to the SES. You should apply directly
to any Federal activity. If you are separated from an SES noncearr e
or limited appointment, you have no reinstatement privileges based
upon such service.
You will be given any lump sum payment that may be due you
for annual leave at the time of separation. Refund of an appropriate
portion of this payment will be required if you are reemployed in .
Federal agency in a position under the same leave system during the
period covered by such payment.

V. Availability of Further Information
Consult your supervisor if you have questions about the ado .
statements or the entries on the front of this form, or about other
matters concerning your employment. This is particularly important
on questions involving granting of leave, assignnient of duts, amnd
hours of work which are generally under the supervisor's control. If
your questions are technical, your supervisor may refer you to your
personnel office, which will have copies of controlling civil service
regulations, as well as your individual records, and so can best
explain how they apply in your case.







Standard Form 50
; R ieMed March ;960
U.S. Offcl o' Personnel Manageme
FPP Chapter 296.
S (F.P Agency Use)

1. Naime. (Cam) Lat-Flrst-Middle



Il V .tman Preference
t~. A t... .. DiMb.
,4,0,. 4 4-I Pt. Comp.


Attachment to FPM Ltr. 296- 76
Page 3 of 21

Notification of Personnel Action
(Employee-See General Information On ieverie)


It


Mr.-MIss-Mr.-Ms.


5-10 Pt. Other
6-10 PtS30% Comp.


2. (For Agency Use)


I6. Tenure Group


I .... .: 10. Retirement
i -Cid (Regular Only-Declined OptionalI -- CS
S'. I2 -lieltlbla 3t-Walved 4-Covered (Rea. and Opt I 2-FICA


ii.






















liii
H,









'H


ii. .ilaturae. Action
itp V


13. Effective Date
(Month. Day, Year)


3. Birth Cato 4. Social Security No.
(Month, Day, Year)


7. Service Comp. Date Laeve
(Month. Day, Year)


3-F5
4-NOwe


11. Leave Blank
5-01ser
6-S Special


14. Clvil Service or Other Legal Authority


3IS Frqml Position Title and Number 16. Pay Plan and 17.(a) Grade (b) Stp 18. Salary
Occupational or or
Code Level Rate


.INt: Nfme Arid Location of Employing Office





I Top Position Title and Number 21. Pay Plan and 22.(a) Grade (b) Step 23. Salary
Occuptlql or or
Code ,f, Level Rate


S... ime and Location of Employing Office






i: Stion (City-County-State) 26. Location Code

.2 paprlation I.lon Occupied 29. Leave

S: % 1,I,5.6-Competitlve Service 3-SES General
2.7.8-ExcePted Service 4-SES Career Reerved


li ri i A. Subject to comp year p nary or trial) period commeniing:
S B. Service counting ent) tenure from:
QCs Chuk, ift ae ed
pnretioam: Show re ns below uired


SupMgr. Indicator Work Schedule Pay Rate Determ. Special Prog. I.D. Educational Level Yr. Degree Attained Academic Discipline

33. ate of Appointment Affidavit (Accessions Only) (Mo., Day, Year) 34. Signature (or Other Authanticatlon) and Title

32. Office Maintalning Personnel Folder (if Different from Employing
Office)

33. CodI Employing Department or Agency
35. Date and SON
6 Prt Previous Edition Usable
O51 36 NSN-7540-00-823-7930
2 Payroll Copy


6. Tenure Group


I;;;;;;;;; '










































21. Pay- Plan and 22.()' Grade
Occupational Ct
Ca ll


Position Occupled

S-- lS6-Competitlve Servim -SES General
2,7.,-Excepted Servin 4-5Kb CarW Reserved


robationary (or trill period commencing,:
p permanent) tenure from:
onl--


Separation:


Sup./Mgr. Indicator Work Schedule Pay Rate DOterm. Special Prog. I.D. |Educatlonal Level Yr. Degree Att ned


31. Date.of Appointment Affidavit (Accessions Only) (Mo., Day, Year)

3ce Maince Maintaining Personnel Folder (if Different from Employing
Office)

33. Co1 Employing Department or Agency
I


34. Signature (or Other Authentication) and Title


3a. Dlat and SON


3. Peronnsi Foler Copy


I
)


`' '""'~";`^


~'--~ ---- ~~- --~~


.. .:


. .... ... .

.. ::::-iIs








ai ,va:d lisM tNOifcall. Prs fl;" o O
VS. of WPsoAnal Malamament .fcat ofPrnA.
iM; hapr n. (Employm-Sm Ga.naL I. f onl t Oi Rp)
.I::-II nn i ... ....... ... .... .. .
A"M o.YIC Uto)


S


MIr.FMIMrMi MI...


. Dtb .. 50 Pt. Other
. Camp. 6-10 PtiO3% Comp.


'(aggla~r only*Deilie Optional)
a 3'-1alval'i ,,-C.o'Jere Re~ aI nd O ha _y


i. (For As"W C 14. SoSal Security No.
00nihi.-N V r)*lri~?


6. Tenure Group C. i ckmp.O DaI* LIa ll. HandlcapCoda
St (iogithD, Yaa v r


I. RAti.rant 1 ii 1. Laav Blank
- \m rt ti. I
2410aA


" .t 1. EffMlwEct Date I .. Clt Brl l or OIier Lagll Authority
(MoAnti Day, Yerl:


TRte and Number


16. hy Plan and
Oecupational
Code


17.(a) Brae
or
Livl|


Ibl qap 13. Salary
or
Rate


add Loalton of Employing Offic


rprmwiml
o- I


MMiMalom:


us stall .at
inure frau:


i


4 US. OffiC of Parm i Mnna*lnmit Copy


*A. Mi f CsMt 4 Fi.Uldd-111te


. ,, ,


--


-----; -


" "


i


--


m




























15. From: Poaltion Title and Number 16. Pay Plan and 17.(a) Grade (b) SteP 18. Salry
Occupational or or
Code LevelI Rite



19. Name and Location of Employing Office



......

20. To: Position Title and Number 21. Pay Plan and 22.(a) Grade (b) Step 23. Slry '
tonal or or
Co& Lvel Rate
ffff


Position Occupied

1.5.6-Competltive Service
2,7,.-Excepted Service


obetionary (or trial) period commencing:
Permanent) tenure from:
on I


bpmrations: Show


Sup./Mgr. Indicator Work Schedule Pay Rate Determ. Special Prog. I.D. EducationalLevel Yr. Degree Attained Academlic:


31. Date of Appointment Affidavit (Accessions Only) (Mo.. Day. Year)

32. Office Maintaining Personnel Folder (If Different from Employing
Office)

33. CI Employing Department or Agency


6 Part
50-136


[34. Signature (or Other Authnontctlon) and Title "


35. Date and SON


5 Chronologicl Jounl File Copy


Previous El
NSMN7540-


35. Data Lind SON


-Ii..


~I







Standard Form 50
Rnlesed March 1980
U.S. Office of Personnel Management
FPM Chapter 296


Attachment to FPM Ltr. 296- 76
Page 7 of 21

Notification of Personnel Action
(Employee-See General Information On Reverse)


(For Agency Use)


1. Name (Caps) Last-First-Middle Mr.-Mlss.Mrs..Ms. 2. (For Agency Use) 3. Birth Date 4. Social Security No.
(Month, Day, Year)


5. Veteran Preference 6. Tenure Group 7. Service Comp. Date Leave
-No 3-10 Pt. Dsab. 5-10 Pt. Other (Month, Day, Year)
2-5 t. 4.10 Pt. Comp. 6.10 Pt./30% Camp.
9. FEGLI 10. Retirement 11. Leave Blank
1-Covered (Regular Only-Declined Optional) 1 -CS 3-FS 5-Oer
2-Ineligible 3-Walved 4-Covered tReq. and Opt.) 2-FICA 4-None S-CS Special
12. Nature of Action 13. Effective Date 14. Civil Service or Other Legal Authority
Code I (Month, Day, Year)


15. From: Position Title and Number 16. Pay Plan and 17.(a) Grade (b) Step 18. Salary
Occupational or or
Code Level Rate



19. Name and Location of Employing Office


Sup.Mgr. indicator I Work Schedule Pay Rate Determ. Special Prog. I.D. Educational Level Yr. Degree Attained Academic Discipline


31. Date of Appointment Affidavit (Accessions Only) (Mo., Day. Year) 34. Signature (or Other Authentication) and Title


32. Office Maintaining Personnel Folder (if Different from Employing
Office)

33. Code Employing Department or Agency

35. Date and SON


6 Part
50-136


Previous Edition Usable
NSN-7540-00-823-7930


6 Utility Copy





Attachment to FPM Ltr. 296- 76
Page 8 of 21

Standard Form 50-8
Revised March 1980
U.S. Office of Personnel Management
FPM Chapter 296


Notification of Personnel Action
(Employee-See General Information On Reverse)


(For Agency Use)

1. Name (Cape) Last-Firt-Mlddle Mr.-Mss-Mrs.-Ms. 2. (For Agency Us) 3. Birth Date 4. Social Security No.
(Month. Day, Year)


5. Veteran Preference 6. Tenure Group 7. Service Comp. Date Leav-
S1-No 3-20 Pt. Dsab. 5-0 Pt. Other (Month. Day, Year)
2-5 Pt. 4-10 Pt. Comp. 6-10 Pt./30% Comp.
9. FEGLI 10. Retirement 11. Leave Blank
-- Covered (Regular Only-Declined Optional) -CS 3-FS SOher
S2-Inelugible 3-Walved 4.Covered (Req. and Opt.) 2-FICA 4-Nonm CS Special
12. Nature of Action 13. Effective Date 14. Civil Service or Other Legal Authority
Code (Month, Day. Year)


IS. From: Positlon Title and Number 16. Pay Plan and 17.(a) Grade (b) Step 18. Salary
Occupational or or
Code Level Rate


19. Name and Location of Employing Office


31. Date of Appointment Affidavit (Accessions Only) (Mo., Day, Year) 34. Signature (or Other Authentication) and Title

32. Office Maintaining Personnel Folder (If Offerent from Employing
Office)

33. Code Employing Department or Agency
SS. Date
5 Part
50-137
1 Emploey Capy




Attachment to FPM Ltr. 296- 74
Page 9 of 21

NOTICE TO EMPLOYEE

KEEP THIS DOCUMENT FOR YOUR RECORDS. IT IS YOUR COPY OF THE OFFICIAL RECORD OF A PERSONNEL
ACTION AFFECTING YOUR EMPLOYMENT. PROMPTLY CALL ANY ERROR TO THE
ATTENTION OF YOUR SUPERVISOR OR YOUR PERSONNEL OFFICE.


I. Condition Pertinent To All Types of Personnel Actions
The personnel action identified on the face of this form is
subject to all applicable laws, rules and regulations governing
Federal employment and may be subject to investigation and
approval by the U.S. Office of Personnel Management. The action
may be corrected or canceled if not in accordance with all legal
requirements, or if based upon your misrepresentation or fraud.
In addition, the grade of the position to which you are
officially assigned may be reviewed and corrected by your agency
personnel office, or by the U.S. Office of Personnel Management.
Items 9 and 10 show common types of payroll deductions:
"FEGLI" for Federal Employees Group Life Insurance, "CS" for
Civil Service Retirement, "FICA" for Social Security, and "FS" for
Foreign Service. Additional deductions may be made under the
Federal Employees Health Benefits Program, and for income taxes,
bonds, and other purposes authorized by law.

II. Information About Appointments
Appointments to positions in the competitive service: The Civil
Service Act places most positions in the "competitive service." The
U.S. Office of Personnel Management sets qualification require-
ments and controls recruitment for such positions. As a general rule,
persons selected from civil service registers to fill continuing jobs in
the competitive service are given career-conditional appointment
Such appointments are secured through direct competition wit%
other members of the general public seeking similar wor
Government agencies, and permit qualified employees to be
without further competitive examination to other jo the
competitive service. Career-conditional appointments become
appointments upon completion of 3 years of substantial on .
ous creditable service.
The first year following a contemporary competition
ment generally is a probationary period during a tee
must demonstrate full competence and fitness
ment. Reinstatements are also subject to a pro r
unless one was previously completed. Transfers, options,
changes to lower grade, and reassignme ing a p onary
period are subject to completion of probe
Temporary appointments do not cb Ie status
and do not lead to a career or jear-c aI appointment
without some further examination d ualifi l Limited tempo-
rary appointments are made wh or suing need for a
person's service, regardless of t I which he or she
qualified for appointment; acceptance of su pointment will not
remove a person's name from a civil servi sister on which he or
she may later be reached for career-conditi al appointment.
Appointments ro positions in the excepted service. Excepted
appointments are made to positions which are excepted from the
competitive service by law or other special authority. Generally the
employing agency sets qualification requirements and conducts
recruitment for such positions. Such appointments do not confer a
competitive civil service status or eligibility for movement to jobs in
the competitive service; they may be made without restrictions on
tenure, with a conditional or indefinite limitation, or with a definite
time limitation. A trial period may be required at the discretion of
the employing office.
Appointment to positions in dte Senior Executive Service
ISESI. SES appointments are made to executive positions with
managerial, supervisory, or policy functions. Initial SES career
appointments are obtained through competition with other civil
service employees, or civil service employees and members of the
general public. The first year of an initial SES career appointment is
a probationary period, during which the appointee must demon-
strata full competence and fitness for such employment.
SES noncareer and limited appointments do not confer
competitive civil service status or lead to SES career appointments.


III. Information About Tenure Group ::
Employees are ranked in tenure groups according to the naoirf
of their appointment: those with unrestricted tenure *re ploii |I
Group 1; those serving under conditional appointment lie.
automatically lead to full tenure after a prescribed time and witi0t Q:
further qualification are placed in Group 2: and thoaeservingu U ,
temporary or indefinite appointments not limited to an exailctI i
or date are placed in Group 3. Within each tenure group, readl.i iliL4
determined by veteran preference, performance rating; aidi^^_ r'%$
Federal service. If it should become neceasry to reduce' ii.li:"!"
employees are selected for separation or change to lower m1 i.,kii
according to the general ranking. Employees serving under c amit::f l
tive appointments and those serving under excepted appbiintpi ::
are ranked separately for reduction in force purposes.
Tenure group a used for reduction in force purposes doe a Ot.
apply to the Senior Executive Service. Codes 4, 5. 6, 7, La, p iI
denote a type of appointment in the Senior Executive SpreWhtr
do not indicate tenure group. The codes mean:
4-SES career appointment-probation completed.
5-SES career appointment-serving probation with plaperaiLit

S career appointment-serving probation without pi lc
en hts in another service. ..
ncreer appointment.
limited term appointment.
SS limited emergency appointment.

ormaton About Your Status After Separation
If you are separated or placed in a nonpay status for:4 ".
extended period, your employing agency will furnish you wit.lh'.I
>Standard Form 8 explaining your rights for unemployment isriB:
dance benefits. If you were covered by the Civil Service Retirement .
System or Federal Employees Group Life insurance, you lhan
previously been furnished certificates describing these progmNt ::
Such certificates have information regarding your rights and pIlibl&l. ;
benefits after separation.

If you are separated from a career or creer-condihional.
appointment, you may have reinstatement eligibility and may apply
directly to any Federal activity and may be employed without
further competitive examination. If you are a nonveteran mnd you
are separated from a career-conditional appointment your eligibility
for reinstatement is generally limited to 3 years from the daa of
separation. If you are separated from a temporary or except
appointment, you have no reinstatement privileges based upon wsch
service.
If you are separated from an SES career appointment, you may
have reinstatement eligibility to the SES. You should apply directly
to any Federal activity. If you are separated from an SES noncarer
or limited appointment, you have no reinstatement privileges based
upon such service.
You will be given any lump sum payment that may be dua you
for annual laWe at the time of separation. Refund of an appropriate
portion of this payment will be required if you are reemployed in a
Federal agency in a position under the same leave system during the
period covered by such payment.

V. Availability of Further Information
Consult your supervisor if you have questions about theibove
statements or the entries on the front of this form, or about other
matters concerning your employment. This is particularly important
on questions involving granting of leave, assignment of duties and
hours of work which are generally under the supervisor's control. If
your questions are technical, your supervisor may refer you to your
personnel office, which will have copies of controlling civil service
regulations, as well as your individual records, and so can best
explain how they apply in your case.




Attachment to FPM Ltr. 296- 76
Rage 10 of 21

Standard Form 50-8
Revised March 190O
U.S. Office of Personnel Management
PPM Chapter 296


Notification of Personnel Action
(Employee-See General Informatfon OnC Reverse)


(For Agency use)


1. Name (Caps) Last-First-Middle


S. Veteran Preference
I-No 3-10 Pt. Dliab.
4-5 Pt. 4-10 Pt. Comp.


Mr-MlIs-Mrs.-Ms.


2. (For Agency Use)


I-t


5-10 Pt. Other
6-10 Pt/30% Comp.


9. FEGLI
-- -Coraed (Regular Only-Declined Optional)
S_ O


6. Tenure Group


10. Retirement
1-CS
L-ICA


3. Birth Date
(Month, Day, Yearl


4. Social Security No.


7. Service Comp. Date Leaw
(Month, oay, Year)


3-FS 5-tther
-.Naone -CS SpeCal


LA. LUUvU Uanfl


I




I ..


12. Nature Of Action 13. Effective Date 14. Civil Service or Other Legal Authority
Code (Month, Day. Year)


15. From: Position Title and Number 16. Pay Plan and 17.(a) Grade (b) Step 18. Salary
Occupational or or
Code Level Rate


19. Name and Location of Employing Office





20. To: Position Title and Number 21. Pay Paig d 22.(a) Grade (b) Step 23. Salary
Occu nalor or
C Level Rate


24. Name and Location of Employing Office





25. Duty Station (City-County-State) 26. Location Code

27. Appropriation 28. Position Occupied 29. Leave
Blank
1.5,6-Competitlve Service 3-SES General
S .7.8-Excepte Service 4-SES Career Reserved
30. Remarks: A. Subject to com ionary (or trial) period commincirng

B. Service counting r permanent tenure from:
C. Check I adl probation
Sepratiom: Show reason be as













32. Date of Appointment Affidavit (Accesrsons Only) (Mb.. Day. Year) 34. Signature (or Other Authentliatlon) and Title

82. Office Maintaining Personnel Folder (If Different from Employing
Office)

83. Cod Employing Department or Agency


5 Part
50137
2 Pyrll Copy






































roa PFitilon TRI and Number


2*. Name. nd Locatlon of Employing Office


Ar


2E. Duty SUaion (City-County-State) i


27. Appmpriatlon


N T .+ Paltion OccUpid
S^1.5,G-Cl npetitive Siriul
2.7.b-Eacepted Servic


3455'l* C Anne sl6rE~m


. Ra: E A. Subject to comp"bt lonery. or trial) period PnhumiWiunui.
B. Service oM9g t v r (or pomwannent) tenure frosm. -, -
C Check l, if I blaon I
Sepw lir: Show remon


31. Date of Appointment Affidavit (Accessions Only) (Mo. Day. Year)

32. Office MabtIMning Personnel Folder (if Different from Employing
Office)


33. C. Employing Department or Agency


S34. Signture (or Other AuthietleltItn) and Til


5 fleI


S- Pesmmel FeMlr Of


C13
'cc


te


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(Far Agency UMse

1. Name (Caps) LastFirst-Middle Mr.-MlssMrs.-Ms2.2. For Agency Ueo 3. Blrth D&t 4. Socil Security No.
(Month, DTy, Vtar)


5. Veteran Preference 6. Tenun Group 7. Sevwce Cogn.O Date Leave B. Handicap Code


I





F,


5-10 Pt, Other
6-10 Pl.30% Camp.


10. Retirement
iaCoqere (Regular Only-Declined Optional) 14 *
4 alrible.3-Walved -CvrdI ad0t12, 4ka
<-Covere5


I (Month. Day, VYela


S11. Leave Blank
- 4pner
6-CS Specal


&








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5 Part
50-137


4 US. Offle of Personnl Ihenment Copy


1 -No 3-10 Pt. Olsab.
*P&il 4-L10 Pt. Comp.


12. NIre of Action .13. Effect ve Date 14. Civii Servle or Other Legal Authority
Code (Month, Day, Year)


15. From: Position Title and Number 16. Pay Plan and 17.a)l Grade (b) Step 18. Salary
Occupational or or
Code LOval Rate


1l. Name and Location of Employing Office





*0. To: Position Title and Number 321. Pay pint 22.a) Grade (h) Step 3a. Salary
: on or or
Co Leve Rato


24. Name and Location of Employing Office





:E5- Duty Station (City-County-State) 2 26. Location Code


27. Appropriation Paoition Occupled 29, Leve
Blank
::. -Comp1tBs.ti Service 3- SE General
2.7,B-Etxceptd Srvlce 44ES Ca rr Reserved
30. Remarks:. A. -a-
A. Subject to complex ,lonary for" tril) period commncling:l

B. Service ( fr permmanen temnue fhroiit: .-
C. Chec, if ra r botion
Seperetlons: Show reasons belo














31. Date of Appointment Affidavit (Accessions Only) (Mo., Day, Year) 34. Signature (or Other Authentication) and Title

32. Office Maintaining Personnel Folder (If Different from Employing
Office)

33. Code Employing Department or Agency
_35, Date





















- 116 3-10 Pt. Dlib.
24 Ps 4-10 Pt. Comp.


5-10 Pt. Other
6-10 Pt./30 Comp.


9. FEULI
I 3-Cowerd (Regular Only-Declined Optional)
C EE tAlWIl d 4a. %r R d Olab .


mmi, cay. i


10. Retlrement
I-FICA


S-WS S-OtUw
uNonaM CS San.mi


1R. Natune of Action 13. Effective DOt 14. Civil Sarvda or Other Ugal Authority
Ceda1 (Month, Day, Year)


15. From, Position Thtl and Number 16. Pay Plan and 17.(a) Grade 1b) Stop 1. Slary
Occupational or or
Code Leue Rate



19. Name and Location of Employing Office


ion Occupied

1.5,6o-Compettlte Servicl 3-SES General
2,7.1-ExceptedService 4-SES Caraer Referved


C. Check. if el
Smratiom: Show resonm below,


4tonrry (or trial) period commencing:
Permanent) tenure from:
on -


31. Date of Appointment Affidavit (Accessions Only) (Mo.. Day. Year) 34. Signature lor Other Authentication) and Title


32. Office Maintaining personnel Folder (f Olfferent from Employing
Office)

3I. Cod Employing Department or Agency .

35. Date
6 Part
50-137
6 Chronologlml Journal PNe Col


Hgii~iE


I


- ----


6 Chronologlml Journal PNe Col


Hg





Attachnent to FPM Ltr. 296- 76
Page 14 of 21
SF 52 Revised March 1980
U.S. Office of Personnel Management
FPM Chapter 296


Request for Personnel Action


Unless otherwrise Instructed, fill in all Items in this part excepttog nietehayIe.Ifplcbeban
PART I REQUES'TING OFFICE: raeainadrnrto aaa aaa ie


1. Name (Caps) Last-First-Middle Mr.-MIss-Mrs.-Ms. 2. (For Agency Use) 3. Birth Date 4. Social Security No.
(Month, Day. Year)


A. Kind of Action Requested B. Request Number C. Date of Request
1. Personnel (Specify Appointment, Reassignment, Resignation, Etc.) (Month, Day. Year)


2 Position (Specify Establish, Review, Abolish, Etc.) D. Proposed Effective Date E. Position Sensitivity


5. Veteran Preference 6. Tenure Group 7. Service Comp. Date Leave B. Leave Blank
1-No 3-10 Pt. Disab. 5-10 Pt. Other (Mo., Da., Yr.)
2-5 Pt. 4-10 Pt. Comp. 6-10 Pt./30% Comp.
9. FEGLI 10. Retirement 11. Leave Blank
Covered (Regular Only-Declined Optional) 1-CS 3-FS S-Other
S2-Ineligible 3-Walved 4-Covered (Reg. and Opt.) 2-FICA 4-None b-CS Specil
12. Nature of Action 13. Effective Date 14. Civil Service or Other Legal Authority
Code (Month, Day, Year)


15. From: Position Title and Number 16. Pay Plan and 17.(a) Grade (b) Step 18. Salary
Occupational Code or or
Level Rate



19. Name and Location of Employing Office




20. To: Position Title and Number 21. Pay d 22.(a) Grade (b) Step 23. Salary
OcCupl de or or
Level Rate



24. Name and Location of Employing Office




25. Duty Station (City-County-State) 126. Location Code


Blank
1, 5. 6-Competitive Service 3-SES General
2, 7, S-Excepted Service 4-5ES Career Reserved
P. Remartk by Requesting Office (Continue ona l G. Requested by (Signature and Title) (Leave Blank on Resignations)



H. For Additional Information Call ( Ol l .) I. Request Approved by (Signature and Title)



PART II TO BE COMPLETED BY PERSONNEL OFFICE (Also Complete Items inside Heavy Lines Above.)
J. Position Classification Action: identical Additional New II Vice 1 Regraded
K. Clearances Initials/Signature and Date (6) 1 certify to the accuracy of the Information entered on this form and that the.
(1) proposed action is In compliance with statutory and regulatory requirements.
Approval Signature and Date (Month, Day, Year)

(2) Calling or Position
Control
(3) (7) Remarks (Note: Use Item 30 on Reverse for SF 50 Remarks.)
Classification Qualification Standard

(4) Placement or
Employment

(5)


NSN-7540-00634-4004
Previous Edition Useble


52-110


(7) Remarks (Note: Use Item 30 on Reverse for SF 50 Remarks.)
Classification Qualification Standard

(4) Placement or
Employment

(5)


NSN-7540-00-634-4004
Previous Edition Useble


52-110







SF 52 Revised March 19O0
U.S. Office of iarmonmi Management
FPM Chapter M96


Page 15 of 21
Request for Personnel Action


Unless otherwlge instructed, fill in all items in thil PArt WREWat thUga tithide the heavy lingg. If
PART I REQUESTING OFFICE:
giser nation and separate .


1. Name (Capsm Lilt-Flrst-Middle Mr.-MiwMrs.-Ms. 2. (For Agency UM) 3. Birth Date 4. Secil SMueitv No.
(Month. Day, Year)


A. Kind of Action Requested B. Request Number C. Data of RegealI
1. Personnel (Specify Appointment, Reassignment, Resignation, Etc.) (Month, Day,.Mf

2. Position (Specify Establish, Review. Abolish. Etc.) D. Proposed Effective Dat E. Position SMlneSl.


5. Veteran Preference 6. Tenure Group 7. Service Comp. Date Laew B. Leave Blank
1-No 3-10 Pt. Dishb. 5-.0 Pl. Other (Mo., De., Yr.)
_. S Pt. 4-10 Pt. Comp. 6.20 Pt./30% Comp.
9. FEGLI 10. Retirement 1e. Leam Blark l
---- 1-Covered ([Reguliar Only-Declined Optional) 1-CS 3-FS i-Olhr,
2-tInlaighbl 3-Walved 4-Covered (Rea. and Opt.) 26FICA 4-None 9-CS Special
12. Nature of Action 13. Effective Date 14. Civil Service or Other Legal Authority ..I.
Code (Month. Day, Year)


15. From: Position Title and Number


16. Pay Plan and
Occupational Code


17.(&) Grade (b) Step 3a. Salary
or or
Level Rate


r~.


LA

~1j


-.,,i ,

::. : ::.


19. Name and Location of Employing Office '. r'..




20. To: Position Title and Number 21. Pay Plan 22.(a) Grade (b) Step 23. Salary ." l
Occup I C or or -
Level Rate


24. Name and Location of Employing Office




25. Duty Station (City-County-State) 26. Location Cil


27. Appropriation Position Occupied I9. LU1y0

1, 5, 6-Competitive Service 3-SES General
2, 7, S-Excepted Service SES Career Reserved
F. Remarks by Requesting Office (Continue on 0. Requested by (Signature and Title) (Leave Blank on ResignationS).



I. For Additional Information Call (N na Phon -) 1. Request Approved by (Signature and Title)



PART 11 TO BE COMPLETED BY PERSONN& FICE (Also Complete Items inside Heavy Lines Above.)
J. Position Classification Action: Identical Additional New Vice Reg|dd
K. Clearances nitials/Signature and Date (6) I certify to the accuracy of the Informatlon entered on this form and tat ItH
(2) proposed action is in compliance with statutory and regulatory requirmnift. .
Approval Signature and Date (Month, Day. Year)

(2) Clling or Position
Control
(3) (7) Remarks (Notei Use item 30 on Reverse for SP 50 Remarks.)
Clasification Qualification Standard

(4) Placement or
Employment

(5)


NSN*.740-0.034.34004
Previous Edition Usable


:: ::::: :
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A, ttaclment to FPM Ltr. 296- 76
Sage 16 of 21


PART III TO BE COMPLETED BY EMPLOYEE
Reason for Resignation (Important Note to Employee Give specific reasons for your resignation. Avoid generaized reasons.)


Effective Date or Resignation Employee's Signature Date Signed (Month, Day. Year)
(Month, Day, Year)


PART IV SEPARATION DATA (To be Completed by Employee When Possible)
Forwarding Address for Communications, Such as Salary Checks and Bonds (Number, Street, City, State. and Zip Code)


PART I CONTINUED)
F. Remarks bY Recuesting Office


Subject to completion of 1 year pr
SService counting toward career (or
Successor Position-Employee retail
Check, if separated during pro
Separations: Show reasons below. a


Sup./Mgr. Indicator Work Schedule


Pay Rate Determ. Special Prog. I.D. Educational Level Yr. Degree Attained Academic Discipline


t U.S. WEM Ifr *IIIENG OTICEa: : 1980 0 310-453 (BS)


.























m mture or Action
*


urIcut,
mtht Day,


IU tJ. % flw %Or waUWa uiulrry


i. fram" Positlon Title and Numbr 16. Pay Plan nd 17M(a) i wal () Step :1. Salary
Occupational or or
Code Level Rate



, Name anO Locatlon of Employing Office


..i .....


A. Subijet to completion of 1
| L *B. Service counting toward. crelo
C. Check, if pattedd
: mper S cntioh: e Show remor below, a qu j
alL-. TA ]


or rw n.. nrOnU rmm ong..... .... .
nur from. ---

": .:


w.Pr. nacator work scI urle Pay Rate Dferm. Special Prog. .D. Eaucatlonal Lvel g Attained I Academic Discipline


i.. Catof Appolntment Affidavit (Accesslon Only) (Mo., Day, Yar)

O::: ffic Maintaining Pmsonmal Folder (If different from Employing
E Offlci)
nCo employing Depertaunt or Agency


iiiiiiEiii~ii:"

;iL" iidiilil .. =......
iii! "ii::ib;i:
[ ...:: s


34. Signature (or Other AutlentiMtlon and TtleC


as. Date and soW


Prvlous Edition Usable
NSN-7540-00-I83-7930
i -Eloft W:plob r r

.. .. ... ...... ..


:~""I' --


--~--~-

































EiSiorec Lin loT Ptlmgieon oIf o y r.py p lurai uuom uann I m w aI IoneI, r pTi...II I eniii
(Month. Day. Year)


PART IV iEPARATION DATA (To b Completed by Employh WMn Paoiblae)
Forwarding Address for Communications. Such as Salary Cecks and Bonds (Number, Street. City, State, nd Zip Code) ...i


.......... .. IiiiW.ii;... ..Dii

PART I (CONTINUED) S :::
F. Remarks by Requesting Office


........ "..=... i; iiiii








PART II CONTINUED)
30. SF 50 Remarrks

Subject to completion of 1 year probationary ia commencing: .. ....
- Service counting toward ucrer for nt) to om-
Successor Position-Employee retain CthiM service.
- Check, i Mplarated during probation.
Seprations: Show reasons below .s required. .-







........Mi l


S:...:.. ..... .







=,/MUp. Indicaor work Schedule- Psy te.Datertm. swal|caif o. EaetorLovel Vr. DegroAftsh--a


S:.. :.... ...... .





Attaglament to FPM Ltr 296v-76
Pagel 19 of 21






PART III TO BE CDIIILETIE BY !MPLOYEE
Romaon for Resignation (important Note to Employee: Give"diC r easons for your resignation5. Avoid generalized reasons.)














Weltotive Oat* of Resignation Emploeve's Signature Date Signed (Monthe Day, Year)
( M o nth D ay Y ea r)I


VARYl IV SEPARATION DATA (To be Completed by Emploexe Whean Poninge
for warding Address for Communications, Such as Sablary Cheeks and Bonds (Number, Street. City, Stathe, ian Zip Coeli)



PART I ICONitTINUllD) Ak
IF. Remarks by Requesting office









PART 11 (CONINUED)Al%
30.s5F so Re marks
anaimtos em plemaltina of I year Prbahtil for adcmmencing
Service counting tow" career (or pe tameu
Successor Position-Employaw retained I rvice.
Check, If separated during probation.
Gepasrstions: Show revisons below, as required.






Attachment to FPM Ltr. 296-76
Page 20 of 21


PART III TO BE COMPLETED BY EMPLOYEE
Reason for Resignation (Important Note to Employee: Ge specific reasons for your resignation. Avoid generalized seasons )


Effective Date of Resignation Employee's Signatue Date Signed (Month, Day, Y. :..:
(Month, Day. Year)
Ua

PART IV SEPARATION DATA (To be Completed by Employee When Possible) .
Forwarding Address for Communications. Such as Salary Checks and Bonds (Number, Street, City. State, and Zip Code)
.. "i* :


F. Remarks by Requesting Office


- Subject to completion of 1 year probationary,
Service counting toward career (or per nt]
S Successor Position.Employee retain c
Check, if separated during probation.
Separations: Show reasons below, as require


Sup./Mgr. Indicator Work Schedule Pay Rate Determ. Special Prog. 1.0. Educational Level Yr. Degree Attained Academic I sitPt



oU.S GOVERNMENT PRINTING OFFICE: 1190- 311-539:30


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