Transmittal Slip (CCPS-4)

Temporary/Contract Employee Time Record (CCPS-5A)

Request for Secondary Employment (CCPS 110)

Policy Review Verification Form (CCPS-56)

Employee Action Request form (CCPS - 212)


Employee Relations


These forms are out-dated.  Please do not use them.  Instead, go to the DPS Policy and Forms pages.

Statement of Grievance (CCPS-58)

Response of Supervisor (CCPS-59)

Appeal of Grievance to Division Director (CCPS-59A)

Response of Division Director (CCPS-60)

Appeal of Grievance to Secretary (CCPS-61)

Employee Advisory Committee Report (CCPS-169)













Exit Interview Questionnaire (CCPS-23)

Separation Clearance Checklist (CCPS-190)

Personnel Action Clearance Form  (CCPS-107)


Recruitment and Selection

Application for Employment (State of NC) 

Vacancy Announcement Request Form (CCPS-168)

Request for Temporary Employee (CCPS-196)

Reference Checking Form (CCPS-200)

Selection Decision Log (CCPS-185)

Offer Letter (CCPS-165)


New Employees

Employee Personal Information (CCPS-202)

Record of Previous Employment (CCPS-72)

Agreements (CCPS-160)

Acknowledgements of Understanding (CCPS-167)

NCID Account Request 


Time and Leave

Advanced Leave Request

Time Sheet Form (Monday start)

Time Sheet Form (Sunday start)

Time Sheet Form (temporary employees)

Doctor's Certification - Employee's Illness (DOL WH - 380-E)

Doctor's Certification - Family Member Illness (DOL WH-380-F)


Leave of Absence Request Form (CCPS-210)


Time Inquiry/Change Request Form (CCPS -213)


Voluntary Shared Leave Application for Recipient (CCPS-170)


Voluntary Shared Leave Application for Donor (CCPS-171)



Benefits, Safety & Health

Annual Building Inspection & Safety Committee Report (CCPS-64)

     Instructions for CCPS-64


Worker's Compensation
Worker's Compensation Employee Handbook

Corvel, WC Authorization, Physicians' Report

N.C. Workers' Compensation Employee Statement and Leave Options (CCPS-2)


Notice of Accident to Employer (Form 18)

Report of Employee Injury or Occupational Disease (Form 19)

Body Fluid Exposure Form (CCPS-187)


Supervisor's Accident/Incident Investigation Report (CCPS-188)


Fax Request for Sworn Law Enforcement Officer to Perform Limited/Full Duty(CCPS-195)

Fax Request for Employee to Perform Limited/Full Duty (CCPS-195A)


OSHA Forms/Reports

Workplace Violence Incident Report (CCPS-203)


Log of Work Related Injuries and Illnesses (CCPS-300)


Summary of Work Related Injuries and Illnesses (CCPS-300A)


Injury and Illness Incident Report (CCPS-301)


Antibody Testing Consent and Consent to Release Medical Information (CCPS-180)


Motion to Investigate Exposure (CCPS-181)


Order to Investigate Exposure (CCPS-182)


Order to Test Blood (CCPS-183)


Employee Antibody Testing Consent and Authorization to Release Medical Information (CCPS-184)


Position Management

Position Description (CCPS-102)


Personnel Action Clearance Form (CCPS-133)


Authorization for Personnel Action due to Extraordinary Exceptions (CCPS-120)


Request for In-Range Salary Adjustment (CCPS-140)


Request for Classification Review of In-Range Checklist (CCPS-141)


Position Action Request Form (CCPS - 208)




Application for Academic Assistance (CCPS-135)

EEOI Participant Registration Form (CCPS-209)

Performance Management/Career Banding

Career Banding Assessment Form (CCPS-142)

Performance Management Work Plan (CCPS-186)

Performance Management, Competency Assessment, and Career Development Plan (CCPS-186CB)

Corrective Action Plan (CCPS-205)

Career Banding Improvement Plan (CCPS-205CB)

Work Plan Additional Goals Addendum (CCPS-206)

Performance Tracking Log (CCPS 207)

Career Banding Tracking Log (CCPS-207CB)

Performance Appraisal Summary Transfer Form (CCPS-175)


Electronic Payment Verification Form (CCPS-7)

Electronic Payment Verification Form-GEMS

Reimbursement of Travel and Other Expenses Incurred in the Discharge of Official Duty (CCPS-51) or Automated travel voucher, or SHP's travel form

Employee Advance Request (CCPS-52)

Moving Quotation (CCPS-78)

Budget Division Authorization (CCPS-153)





Direct Deposit Enrollment and Change Form (CCPS-1)


Payroll Address Change Form (CCPS-3)


Internal Revenue Service Employee's Withholding Allowance Certificate

NC Department of Revenue Employee's Withholding Allowance Certificate (NC-4)


« this page last modified 03/07/14 »