Form Usfj Form 11ej-Personnel Action Request / Official Notification Of Iha Personnel Action Page 2

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PRIVACY ACT STATEMENT
AUTHORITY: 5 US Code Section 552(e)(3)
To authenticate and record the personnel action request/notification of official personnel actions.
PRINCIPAL PURPOSE(S):
ROUTINE USE(S): Used by both USFJ installations and the Government of Japan in effecting personnel action requests. The information provided
may be disclosed to any DoD component in the pursuit of their official duties.
WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION:
The information solicited in this form is mandatory for officials of both USFJ installations and the Government of Japan effecting personnel action requests.
Failure to respond will preclude effecting the personnel action request in accordance with the Master Labor Contract, and the Mariners Contract.
INSTRUCTIONS FOR PREPARATION OF PERSONNEL ACTION
REQUEST/OFFICIAL NOTIFICATION OF IHA PERSONNEL ACTION
1. General
a. The request will be prepared by the using organization officer and forwarded to the appropriate Contracting Officer's Representative (COR) for
MLC/MC or authorized CPO/HRO Representative for IHA for initiating and processing various types of personnel actions to the appropriate Regional
Defense Bureau (RDB)/Regional Defense Office (RDO). The original of the form will be signed by the requesting
and approving officials, and COR. The number of copies of the form to be prepared and distributed will be determined at the local level.
The RDB/RDO will complete the necessary action and return the form to the using organization through the COR or CPO/HRO Representative.
b. In the event that there is insufficient space in any of the numbered blocks of the form, additional information may be entered on separate
sheets with reference to the appropriate block numbers.
c. Attach resignation request form to the personnel action request for resignation.
2. Entries in numbered blocks (self-explanatory blocks omitted):
a. Block 1A: Show date of birth (year-month-date) by use of figures: e.g., 20000215.
b. Block 3: For MLC and IHA employees, enter organization or organization symbol and request number in consecutive sequence, i.e.,
USAPAJ-1. For MC employees, enter organization or organization symbol and request number in consecutive sequence prefixed by letter "M" for
mariners, i.e., MSTS-M1.
c. Block 7: For MLC and IHA employees, enter "Limited Term", "Limited Term-Extended", "Trial Period", "Permanent", or "Post Retirement". For
MC employees, no entry required.
d. Block 10: Enter organization code or organization symbol along with organization name.
e. Block 12: For clarification, see paragraph 5a, Section B, Chapter 1 of the Master Labor Contract; paragraphs 1 and 2, Section B, Chapter 3 of
the Mariners Contract; and paragraph 1b, Section A, Supplement 15 of the Indirect Hire Agreement.
f. Block 13A: For non-permanent employees only.
g. Block 13C: Enter weekly work days and hours, e.g., Mon-Fri, 40 hrs.
h. Block 13D: Enter designated non-work day and rest day, e.g., Sat and Sun.
i. Block 14: On termination actions, indicate date of employment. On work schedules, indicate changes. Fill or attach schedule patterns for
those who are on shift or intermittent work schedules.
j. Block 15: Enter the accounting and appropriation data and Fiscal Station-Using Unit-Cost Entity (FS-UU-CE) codes to which the costs of
personnel action requested are chargeable and for which the available balances are sufficient to cover the costs thereof.
k. Block 18: For use by personnel office or equivalent.
USFJ FORM 11EJ, 20120315 (REVERSE)

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