EFFECTIVE DATE OF ACTION 
     Appointment 
      Change 
      Separation 

     

SEPARATION 

  
 19.   Resignation** 
 20.   Job Abandonment 
 21.   Dismissed 
 22.   Layoff**
 23.   Retirement 
 24.   Expiration of Temp. Appointment 
 25.   Termination without Prejudice** 
 26.   Death 

 
 
 

 

*Items 19, 22, & 25 – is re-employment 
ecommended? 

 

         

  *

r 

           Yes 

       No 

Soc. Sec. Number 

Soc. Sec. Number 

PERSONNEL ACTION 

CHANGE 

        
        10.     Prob. Salary Increase 
        11.     Annual Merit Raise 
        12.     Special Salary Increase 
        13.     Name Change 
        14.     Suspension 
        15.     Return from Suspension 
        16.     LWOP 
        17.     Return from LWOP 
        18.     OTHER 
        28.     Tax Change 
        31.     Status Change Only 
        47.     Change Address 
* If different from originally reported date. 

PART I. – TYPE OF ACTION (check One) 

tate of Alabama 

Unified Judicial System 

orm PERS-26A    Rev. 11/13

  S

  F

APPOINTMENT  

        
       1.     Original  
       2.     Promotion  
       3.     Reinstatement  
       4.     Temporary  
       5.     Trainee  
       6.     Demotion  
       7.     Reassignment  
       8.     Emergency  
       9.     Confidential 

Position Number 

    Name (Last, First, MI) 

Position Number 

    Name (Last, First, MI) 

Job Code 

     Class Title 

Job Code 

     Class Title 

Street Address 

Street Address 

Pay Rate 

Grade 

  Step  Part-time 
Hrs./Wk 

 Pay Rate 

Grade 

  Step  Part-time 
Hrs./Wk 

Funding 
State 
Grant
Reimbursement 
Funding 
State 
Grant
Reimbursement

 

State 

Zip Code 

Sex 

Race 

Date of Birth 

State 

Zip Code 

Sex 

Race 

Date of Birth 

City 

City 

Pers. Stat.  Vet. Stat.  Ed. Code 

       D.O.S. 

         UJS Service Date      Total Service Date          Longevity Date          Merit Salary Date 

Pers. Stat.  Vet. Stat.  Ed. Code 

       D.O.S.            UJS Service Date         Total Service Date          Longevity Date 

       Merit Salary Date 

PART III. – AOC USE ONLY 
 

   1. Federal Tax Status 

   2. State Tax Status 

   3. Health Insurance 

   4. Retirement 

 

 

 

PART II. – SEPARATION PAY INFORMATION 

PAYROLL 

HR 

 

 

 

 

PART IV. – REMARKS & APPROVAL – APPOINTING AUTHORITY 
Explain any actions which are not self-explanatory) 

  (

1. Hours in pay status during pay period of term 

2. Annual Leave hours due employee. 

3. Sick Leave hours due retiring employee. 

4. Personal Leave Day 

 

 

 

 

ART V. – REMARKS & APPROVAL – AOC USE ONLY 
Explain any actions which are not self-explanatory) 

                                                                                                                               
                                                                                                                           

APPOINTING AUTHORITY: Typed Name & Title   
 
Signature 

Date 

 

APPROVED BY: Typed Name & Title 

Vonda C. Sanders, UJS HR Director
Signature 

Date 

 

A 

B 

C 

D 

F 
R 
O 
M 

T 
O 

F 
R 
O 
M 

T 
O 

F 
R 
O 
M 

T 
O 

F 
R 
O 
M 

T 
O 

     

  (

   

   

  P

  Personnel status Code:  Enter the appropriate code  from the following 
code index. 

00  Probationary (Confidential) 
01  Probationary (Merit) 
02  Temporary 
03  Trainee 
04  Permanent (Merit) 

05  Emergency 
06  Permanent (confidential) 
07  Leave without Pay 
08  Elected Officials 
09  Appointed Officials 

Less than high school 

1. 
2.  High school graduate or GED equivalent 
3.  High school and business school and/or community 

college. 
4.  B.A. or B.S. 
5.  Masters 
6.  PhD or Law Degree 

D.O.S: Enter projected date of separation for temporary and emergency 

appointments only. 

UJS  Service  Date:    On  original,  reinstatement,  and  confidential 
appointments, enter date of appointment to Court Service, exclusive of any 
other State service. 

Total  Service  Date:    On  original,  reinstatement  and  confidential 
appointments,  enter  the  date  of  original  employment  in  State  Service.  
Leave  this  block  blank  for  temporary  and  emergency  appointments.  This 
date will be adjusted one day forward for each day of suspension. 
 
  Longevity  Date: To be completed by AOC. 
. 
  Merit  Salary  Advancement  Anniversary  Date: 
  On  original, 
 
reinstatement  and  confidential  appointments,  enter 
the  date  of 
appointment.    Leave  this  block  blank  for  temporary  and  emergency 
appointments.  This  date  will  be  adjusted  one  day  forward  for  each 
consecutive  calendar  day  of  LWOP  in  excess  of  15  and  one  forward  for 
each  day  of  suspension.  This  date  will  be  changed  to  coincide  with  the 
effective  date  of  any  subsequent  merit  raise  approved  for  the  employee. 
And for a raise upon promotion. 

 

   

   

   

   

   

1.  White 
2.  Oriental 
3.  American Indian 
4.  Black 
5.  Hispanic 

PART I – SECTION D 

 

 

 
 

 

 

index: 

 

  

  

Effective Date of Action: 
  Appointments should, if possible, be set on the first work day of pay 
period. However, if circumstances require earlier appointment, please be 
aware that in order for the employee to be paid on the regular payroll for 
the current pay period, this form must reach the AOC no later than noon 
of  the  Wednesday  following  the  end  of  the  pay  period,  or  the  employee 
will  be  paid  on  a  supplemental  payroll,  which  will  generally  result  in  a 
late payment. 

Probationary  Salary  Increase  (Item  10)  shall  be  effective  the 
beginning  date  of  the  pay  period  following  the  completion  of  the 
probationary period. 

Annual  Merit  Raise  (Item  11)  shall  be  the  beginning  date of the first 

full pay period in the month of the merit salary date. 

Special Salary Increase (Item 12) will be the beginning date of a pay 

Name Change (Item 13) may be the date the Personnel Action form is 

prepared, or the date of the change. 

For  other  actions,  the  effective  date  is  determined  generally  by  the 
associated facts, for example, the first day of leave without pay (LWOP) 
or  suspension,  or  the  day  the  employee  returns  from  LWOP  or 
suspension.  On retirement, the last day of the month prior to the month 
of retirement.  For other separations, the last day in pay status. 

General  Instructions:  On  original  appointments,  please  make  an 
appropriate  entry  in  the  shaded  “To”  block  of  the  form.    On  all  other 
actions, please complete the following white “From” blocks to fully identify 
the employee: 
 
 
 

Position Number 
Name 
Social Security Number 

 
 
 

hereafter,  only  items  being  changed  need  be  completed,  but  always 

complete both the “Form” and “To” blocks of any item changed. 
 

INSTRUCTIONS ON SPECIFIC ITEMS 
 
PART I – SECTION A 

Position  Number:  A  nine  digit  number  consisting  of  an  expense 
accounting code, country and unit codes, and the actual position number; 
for example, 3-01-100-002. 

Name: Enter exactly as shown on employee’s security card, last name 

first. 

without a social security number. 
 

PART I – SECTION B 

Job Code: The number identifying the classification, as taken from the 

class specification. 

Class Title : The title of the classification approved for the position. 

Pay  Rate  :    The  semi-monthly  rate  of  pay,  or  hourly  rate,  if  paid  by 

the  hour. 

Grade:  A two digit number identifying the salary range assigned to the 

classification in the pay plan. 

Step:    The  number  of  the  step  in  the  pay  range  for  the  pay  rate  as 

shown in the pay plan. 

Part  –  time:  Enter  the  total  hours  per  week  that  the  employee  will 
work,  for  example,  “20’.  Enter  N/A  for  full-time  employees.  Enter 
IRREGULAR if applicable. 

Funding : Check funding source for this position. 

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

   

 
 

  T

PLEASE READ PRIOR TO COMPLETING FORM 

PART I – SECTION C 

PART I 

  Sex: Enter “F” for female and “M” for male. 

  Race: Enter the Race Code, as appropriate, from the following codes: 

Social Security Number: No employee may be placed on the payroll 

  For all forms needed to accompany  personnel actions contact AOC.

 

period. 

Education Code: Enter the appropriate code from the following code