HR103 (a) Temporary Appointment
HR 103 (a)_V4 Jan 2017 Page 1 of 2 Revised 25/01/2017
This form should be used for Permanent Employees on a Temporary Appointment in line with the provisions of
circular 17/2013. For periods of less than 3 months no payment is due. Form 103b to be used for Support Service
Staff where payment is due for short periods. Please complete in Block Capitals/Tick appropriate boxes. Format
date fields as DDMMYYYY
Section 1. Employee Details
Surname:
First Name:
Personnel No:
PPS No:
Section 2. Period of Temporary Appointment
From date
End date
If this is an extension of Temporary Appointment, was the initial period > 3 months: Yes No
If no, will the total period including the extension now be > 3 months: Yes No
Initial start date if this is an extension:
Date:
Reason for Temporary Appointment (tick the relevant one)
Cover Planned Leave Cover Unplanned Leave Permanent Vacancy
Section 3. Temporary Appointment Position Details
Position No
Grade
Pay Scale Type
Annual Salary
Pay scale level
Care Group (If
applicable)
Personnel Area
Contract Type
Incremental date of Temporary Appointment position
Date
Incremental date of substantive post
Date
Name of substantive post
holder
Position No. of
substantive post
holder
Section 4. Planned Working Hours: (if applicable) (SAP Phase II Specific)
Work Schedule Rule (Code)* Please contact your local HR/Payroll office for
list of available codes
Standard Hours of the Higher Post:
Contracted Working Hours of Higher Post:
Start Week of Rotational
Roster
Working Week (tick the
relevant one)
5 over 5
(Mon Fri)
5 over 7
(Mon-Sun)
Section 5. Line Managers Declaration
I declare that the above information is accurate and correct on the date indicated below and that the appointment
conforms with the provisions of circular 17/2013 & guidance document.
Name:
Grade:
Signature:
Date
Contact Phone No:
Mobile Phone No:
E-mail Address:
If faxing please ensure Employee’s Name and Personnel No are included on each page of the form
Employee Name: Personnel No: ____
HR 103 (a)_V4 Jan 2017 Page 2 of 2 Revised 25/01/2017
Section 6. Employees Declaration
I accept the temporary appointment as detailed above. I understand and accept that as this appointment is for a
fixed term and a specific purpose and that the Unfair Dismissals Act 1977 will not apply to the termination of this
temporary appointment.
Signature:
Date:
Name:
Grade:
Contact Phone No:
Mobile No:
e-mail address:
Section 7. Delegated Officer / HR Manager Approval
Name (Print)
Signature
Tel No.
Date
Decision No.
Section 8. To be completed by Human Resources, Personnel Administration
System Updated By (Name):
Grade:
Date:
Comments:
Section 9. Local Payroll
System updated by (Name):
Grade:
Date:
Contact Phone No:
Section 10. Payroll Interface (Sap Phase I specific)
Location:
Wage Type:
Payroll Area:
Employment Signal:
Payroll Area Change Details:
Date:
System updated by:
Name:
Circulation List:
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