Name:_____________________________________ Employee Number: _________________________

Date of Appointment:__________________ Position: ________________ Status: ________________

Area of Specialization: Major: _______________________ Minor: ____________________________
With Special Training: _________________ NC Certificate: _______________________
Highest Educational Attainment (As of June 30, 2018) _____________________________________________
Teaching Assignment: ______________________, ______________________, ______________________,
_____________________, ______________________, ______________________,______________________,
_____________________, ______________________, ______________________,______________________,
Ancillary Services: __________________________________________________________________________
__________________________________________________________________________________________________

__________________________________________________________________________________________________

Signature: ____________________________________________

Name:_____________________________________ Employee Number: _________________________

Date of Appointment:__________________ Position: ________________ Status: ________________
Area of Specialization: Major: _______________________ Minor: ____________________________
With Special Training: _________________ NC Certificate: _______________________
Highest Educational Attainment (As of June 30, 2018) _____________________________________________
Teaching Assignment: ______________________, ______________________, ______________________,
_____________________, ______________________, ______________________,______________________,
_____________________, ______________________, ______________________,______________________,
Ancillary Services: __________________________________________________________________________
__________________________________________________________________________________________________

__________________________________________________________________________________________________

Signature: ____________________________________________

Name:_____________________________________ Employee Number: _________________________

Date of Appointment:__________________ Position: ________________ Status: ________________
Area of Specialization: Major: _______________________ Minor: ____________________________
With Special Training: _________________ NC Certificate: _______________________
Highest Educational Attainment (As of June 30, 2018) _____________________________________________
Teaching Assignment: ______________________, ______________________, ______________________,
_____________________, ______________________, ______________________,______________________,
_____________________, ______________________, ______________________,______________________,
Ancillary Services: __________________________________________________________________________
___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Signature: ____________________________________________