TO: _______________________________
FROM: Rebecca Vipperman, HR Manager
Central Carolina Technical College
SUBJECT: Certification of Prior State Service and/or Leave Information
Employee: _______________________________
SSN xxx-xx-___________
DATE: __________________
I certify that the above employee was in a permanent position from _________________ to ____________________ in
the following position(s):
___________________________ Full-time TGP Part-time
___________________________ Full-time TGP Part-time
___________________________ Full-time TGP Part-time
Annual Leave
Sick Leave
Taken YTD
________________
Taken YTD
________________
Accrual Rate
________________
Balance to Transfer
________________
Balance to Transfer
________________
Family Sick Leave Taken YTD
________________
FMLA Hours taken YTD
________________
_______________
TERI? NO
YES Start Date _____________
_______________________________
Signature
_______________________________
Date
If you have any questions, please contact Rebecca Vipperman, 803-778-7817.
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