Author: Personnel Services Office
Last saved by: Lyell, Renee M
Company: University of Illinois

EMPLOYEE GROUP CHANGE AUTHORIZATION
University of Illinois at Urbana-Champaign

Name: ________________________________UIN:___________________________________

Department: ___________________________________________________________________

Classification: __________________________________ Position Number: ________________

I have accepted an academic appointment effective: ___________________________________
(academic professional, faculty, graduate assistantship, etc) 

I understand that by accepting an academic appointment my seniority and other employment rights under the State Universities Civil Service System will be terminated as of the close of business on my last day of work in my Civil Service classification.

I also understand that if I am currently in a classification represented by a bargaining unit and pay union dues, dues deductions will continue unless I sign a revocation card available at Payroll Customer Service.

________________________________________
Name

________________________________________
Street

________________________________________
City, State, Zip Code

________________________________________
Home Phone Number

I certify that this change in employee group is executed by me voluntarily and of my own free will.

______________________________________	__________________________
Signature							Date							
______________________________________	__________________________
Accepted by Staff Human Resources			Date

c:	Personnel File
	Employee
	Department

C:\Documents and Settings\zorkahn\Local Settings\Temporary Internet Files\OLK22\Employee Group Change Authorization.doc
08/2006