Standard Form 52



Standard Form 52Rev. 7/91U.S. Office of Personnel ManagementFPM Supp. 296-33, Subch. 3REQUEST FOR PERSONNEL ACTIONPART A - Requesting Office (Also complete Part B, Items 1, 7-22, 23, 32,33, and 39)1. Actions Requested2. Request Number FORMTEXT LWOP-US FORMTEXT ?????3. For Additional Information Call (Typed Name and Telephone Number)4. Proposed Effective Date FORMTEXT NAME OF PERSON TO CONTACT (785) 274-XXXX FORMTEXT MM-DD-YYYY5. Action Requested By (Typed Name, Title, Signature and Request Date)6. Action Authorized By (Typed Name, Title, Signature, and Concurrence Date) FORMTEXT SIGNATURE AND TYPED NAME, NORMALLY EMPLOYEE FORMTEXT SIGNATURE AND TYPED NAME, COMMAND ADMINISTRATIVE OFFICER/DIRECTORATE/WING COMMANDERPART 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 Number3. Date of Birth4. Effective Date FORMTEXT I.M. EMPLOYEE FORMTEXT 123-45-6789 FORMTEXT MM-DD-YYYY FORMTEXT ?????FIRST ACTIONSECOND ACTION5-A. Code5-B. Nature of Action6-A. Code6-B. Nature of Action FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5-C. Code5-D. Legal Authority6-C. Code6-D. Legal Authority FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5-E. Code5-F. Legal Authority6-E. Code6-F. Legal Authority FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????7. FROM: Position Title and Number15. TO: Position Title and Number FORMTEXT BUDGET ANALYST POSITION AND POSITION DESCRIPTION NUMBER (OBTAINED FROM FULL-TIME MANNING DOCUMENT) FORMTEXT 8. Pay Plan9. Occ. Code10. Grade or Level11. Step or Rate12. Total Salary13. Pay Basis16. Pay Plan17. Occ. Code18. Grade or Level19. Step or Rate20. Total Salary21. Pay Basis FORMTEXT GS FORMTEXT 2122 FORMTEXT 11 FORMTEXT FORMTEXT ????? FORMTEXT ????? FORMTEXT FORMTEXT FORMTEXT FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????12A. Basic Pay12B. Locality Adj.12C. Adj. Basic Pay12D. Other Pay20A. Basic Pay20B. Locality Adj.20C. Adj. Basic Pay20D. Other Pay FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????14. Name and Location of Position's Organization22. Name and Location of Position's Organization FORMTEXT JFHQ-KSNG 2800 SW TOPEKA BLVDTOPEKA, KS 66611-1287*POSITION EMPLOYEE CURRENTLY IS IN** FORMTEXT EMPLOYEE DATA23. Veterans Preference24. Tenure25. Agency Use26. Veterans Preference for RIF FORMTEXT ???1 - None2 - 5-point3 - 10 Point/Disability4 - 10-Point/Compensable5 - 10 Point/Other6 - 10-point/Compensable/30% FORMTEXT ???0 - None1 - Permanent2 - Conditional3 - Indefinite FORMTEXT ??? FORMCHECKBOX YES FORMCHECKBOX NO27. FEGLI28. Annuitant Indicator29. Pay Rate Determinant FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ???? FORMTEXT ?????30. Retirement Plan31. Service Comp. Date (Leave)32. Work Schedule33. Part-Time Hours Per FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Biweekly Pay PeriodPOSITION DATA34. Position Occupied35. FLSA Category36. Appropriation Code37. Bargaining Unit Status FORMTEXT ????1 - Competitive Service2 - Excepted Service3 - SES General4 - SES Career Reserved FORMTEXT ????E - ExemptN - Nonexempt FORMTEXT ????? FORMTEXT ?????38. Duty Station Code39. Duty Station (City - County - State or Overseas Location) FORMTEXT ????? FORMTEXT CITY, COUNTY, STATE (I.E. TOPEKA, SHAWNEE, KANSAS)40. Agency Data41.42.43.44. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????45. Educational Level46. Year Degree Attained47. Academic Discipline48. Functional Class49. Citizenship50. Veterans Status51. Supervisory Status FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ???1 - USA 8 - Other FORMTEXT ??? FORMTEXT ????? FORMTEXT ??? FORMTEXT ?????PART C - Review and Approvals (Not to be used by requesting office)1. Office/FunctionInitials/SignatureDateOffice/FunctionInitials/SignatureDateA. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????D. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????B. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????E. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????C. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????F. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????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.SignatureApproval Date FORMTEXT ????? FORMTEXT ?????CONTINUED ON REVERSE SIDEOVEREditions Prior to 7/91 Are Not Usable After 6/30/93NSN 7540-01-333-6239PART D - Remarks by Requesting Office(Note to Supervisors: Do you know of additional or conflicting reasons for the employee's resignation/retirement? FORMCHECKBOX Yes FORMCHECKBOX NoIf "YES", please state these facts on a separate sheet and attach to SF 52.) FORMTEXT USED WHEN EMPLOYEE ENTERS MILITARY TRAINING OR ACTIVE DUTY.ORDERS SHOWING A BEGINNING AND ENDING DATE OF TRAINING OR ACTIVE DUTY ORDERS MUST BE ATTACHED TO SF 52. EMPLOYEE MUST ALSO RECEIVE A BRIEFING ON HIS/HER USERRA BENEFITS PRIOR TO DEPARTING FOR TRAINING.EMPLOYEE MUST ATTACH COMPLETED TECHNICIAN ACTIVATION CHECKLIST. THIS CHECKLIST CAN BE OBTAINED FROM EMPLOYEE SERVICES IN HRO.LEAVE CODE FOR TIME CARD IS: KGPART E - Employee Resignation/RetirementPrivacy Act StatementYou are requested to furnish a specific reason for your resignation or retirement and a forwarding address. Your reason may be considered in any future decision regarding your re-employment in the Federal service and may also be used to determine your eligibility for unemployment compensation benefits. Your forwarding address will be used primarily to mail you copies of any documents you should have or any pay or compensation to which you are entitled.This information is requested under authority of sections 301, 3301, and 8506 of title 5, U.S. Code. Sections 301 and 3301 authorize OPM and agencies to issue regulationswith regard to employment of individuals in the Federal service and their records, while section 8506 requires agencies to furnish the specific reason for termination of Federal service to the Secretary of Labor or a State agency in connection with administration of unemployment compensation programs.The furnishing of this information is voluntary; however, failure to provide it may result in your not receiving: (1) your copies of those documents you should have; (2) pay or other compensation due you; and (3) any unemployment compensation benefits to which you may be entitled.1. Reasons for Resignation/Retirement (NOTE: Your reasons are used in determining possible unemployment benefits. Please be specific and avoid generalizations. Your resignation/retirement is effective at the end of the day - midnight - unless you specify otherwise.) FORMTEXT 2. Effective Date3. Your Signature4. Date Signed5. Forwarding Address (Number, Street, City, State, Zip Code) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PART F - Remarks for SF 50U.S.GPO: 1996-404-763/40019 ................
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