Attachment A (Standard Form 52) - Request For Personnel Action

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Standard Form 52
"Attachment A" - Absent-US
Rev. JUL 1991
U.S. Office of Personnel Management
REQUEST FOR PERSONNEL ACTION
FPM Supp. 296-33, Subch. 3
PART A -- Requesting Office
(Also complete Part B, Items 1, 7-22, 32, 33, 36 and 39.)
1. Actions Requested
2. Request Number
ABSENT-US
NTE
3. For Additional Information Call
(Name and Telephone Number)
4. Proposed Effective Date
1st Level Supervisor, DSN 123-4567
MM/DD/YYYY
5. Action Requested By
6. Action Authorized By
(Typed Name, Title, Signature, and Request Date)
(Typed Name, Title, Signature, and Concurrence Date)
MM/DD/YYYY
MM/DD/YYYY
PART B -- For Preparation of SF 50
(Use only codes in FPM Supplement 292-1. Show all dates in month-day-year order.)
1. Name
(Last, First, Middle)
2. Social Security Number
3. Date of Birth
4. Effective Date
999-99-9999
Employee Name
MM/DD/YY
FIRST ACTION
SECOND ACTION
5-A. Code
5-B. Nature of Action
6-A. Code
6-B. Nature of Action
5-C. Code
5-D. Legal Authority
6-C. Code
6-D. Legal Authority
5-E. Code
5-F. Legal Authority
6-E. Code
6-F. Legal Authority
15. TO: Position Title and Number
7. FROM: Position Title and Number
Position Description Title: Office Automation Clerk
Position Description (PD)# & Sequence #70027-78539
9. Occ. Code
10. Grade or Level
11.Step or Rate
12. Total Salary
13. Pay Basis
16. Pay Plan
17. Occ. Code
18. Grade or Level
19.Step or Rate
20. Total Salary/Award
21. Pay Basis
8. Pay Plan
0326
PA
05
$0.00
02
GS
12A. Basic Pay
12B. Locality Adj.
12C. Adj. Basic Pay
12D. Other Pay
20A. Basic Pay
20B. Locality Adj.
20C. Adj. Basic Pay
20D. Other Pay
14. Name and Location of Position's Organization
22. Name and Location of Position's Organization
THE ADJUTANT GENERAL-ID
HHC 116 BDE-ID or
124 OPS SPT FLT
(CLEARTEXT NAME OF THE UNIT)
EMPLOYEE DATA
23. Veterans Preference
24. Tenure
25. Agency Use
26.Veterans Preference for RIF
1 - None
3 - 10-Point/Disability
5 - 10-Point/Other
0 - None
2 - Conditional
1
YES
NO
2 - 5-Point
4 - 10-Point/Compensable
6 - 10-Point/Compensable/30%
1 - Permanent
3 - Indefinite
27. FEGLI
28. Annuitant Indicator
29. Pay Rate Determinant
30. Retirement Plan
32. Work Schedule
33. Part Time Hours Per
31. Service Comp. Date (Leave)
Biweekly
Full time or Part time
F
Pay Period
POSITION DATA
34. Position Occupied
35. FLSA Category
36. Appropriation Code
37. Bargaining Unit Status
E - Exempt
3 - SES General
1 - Competitive Service
2
E
N - Nonexempt
4 - SES Career Reserved
2 - Excepted Service
38. Duty Station Code
39. Duty Station
(City -- County -- State or Overseas Location)
CITY:Boise COUNTY:Ada STATE:Idaho
40. Agency Data
41.
42.
43.
44.
50. Veterans Status
51. Supervisory Status
49. Citizenship
45. Educational Level
46.Year Degree Attained
48. Functional Class
47. Academic Discipline
1 - USA 8 - Other
PART C - Reviews and Approvals
(Not to be used by requesting office.)
1. Office/Function
Initials/Signature
Date
Office/Function
Initials/Signature
Date
A.
D.
B.
E.
C.
F.
Signature
Approval Date
2. Approval: I certify that the information entered on this form is accurate and that the proposed action
is in compliance with statutory and regulatory requirements.
Editions Prior to 7/91 Are Not Usable After 6/30/93
CONTINUED ON REVERSE SIDE
OVER
52-118
NSN 7540-01-333-6239
APD PE v2.00

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