ࡱ> AC@ bjbj,, ("NN @ @ 8OkN&(0%%%%%%%'*%%*&***%*%**y$h%-$% &0N&$(+*(+ %*%%@ :   鶹P Mobile Communication Allowance Form Fiscal Year ______ ______________________________ ____________________________ Name (Last, First, MI) Banner ID number _________ _________________________ ______________________ Position # Department Campus Address _______________________________ _______________________________ Fund/Org E-mail Address The fund code to pay the reimbursement must be the same as the individuals position fund code. Please check one  FORMCHECKBOX  New enrollment  FORMCHECKBOX  Renew existing enrollment  FORMCHECKBOX  Discontinue enrollment Monthly Mobile Communication Plan Allowance Options (Department Head Initials required next to option selected): Communication plan ____ $25.00 Basic (350 min) tier service ____ $40.00 Medium (351-700 min) tier service ____ $60.00 Extended (over 700 min voice/data) tier service To enroll: The original form should be submitted to the divisional Vice-Chancellor for approval. The original form with signatures is submitted to DoIT for recording purposes. The original form with signatures is submitted by DoIT to Human Resources. One copy should be retained for departmental files One copy should be provided to the employee. Employee will be enrolled in reimbursement program at the first of the following month the application is received in Human Resources. First payment is included in the employees pay at the end of the enrollment month. To discontinue enrollment- must be submitted within five day of an employee notice: The original form with signatures is submitted to DoIT for recording purposes. The original form with signatures is submitted by DoIT to Account Payable One copy should be retained for departmental files One copy should be provided to the employee. Appropriate partial reimbursement will be paid in the employees salary at the end of the month that the deactivation notice is received in Human Resources. I have read the 鶹P policy concerning the Mobile Communication Allowance and understand the associated Employee Responsibilities. I understand that this allowance is NOT part of my base salary. I also understand that any equipment purchased or contract provisions of any communication service plan entered into related to this program are my personal responsibility. It is my further understanding that when used for business purposes, my personal mobile communication device usage records are subject to public disclosure in accordance with North Carolina public records law (NCGS 132 et al.). ___________________________ __________________ Employee Signature Date APPROVED: ______________________________________ __________________ Financial Manager/Department Head Signature Date _________________________________ ___________________ Vice Chancellor Signature Date _________________________________ ___________________ DoIT Representative Review Date July 20, 2010 <= \ ^ b k    , - ; < = T U V W ƻߝ߯ߋ߯yn`h-h+P5CJ\aJh+P5CJ\aJ#jhP h+PCJUaJ#jthP h+PCJUaJ#jhP h+PCJUaJjh+PCJUaJh-h+PCJaJhlFh+P5 h+P5hE\Ah+P5CJaJh+PCJaJhBh+PCJaJ h+P5\ hYF5\$<=z  O k U V W  8 v w 7$8$H$gd+P $7$8$H$a$gd+PW _ f      7 = C D E F w c r &CFJ1ȷ١򙡙򙡙򙡙x򡙡h-h+PCJaJhGh+PCJaJh' h+PCJaJh+PCJaJhBh+PCJaJh+P6CJ]aJ h-h+P56CJ\]aJ hBh+P56CJ\]aJhBh+P6CJ]aJh+P5CJ\aJhBh+P5CJ\aJ/ ) t UD`akl23gd+P 7$8$H$gd+P & F7$8$H$gd+P1Y[`aj13;ijh+Phgh+PCJh-h+PCJaJh+PCJaJhBh+PCJaJ3j$a$gd+Pgd+P 7$8$H$gd+P&1h:p+P/ =!"#$%tDeCheck1tDeCheck2tDeCheck32 0@P`p28 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p(8HXf~_HmH nH sH tH @`@ yGNormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR Table Normal4 l4a (k ( No List jj |_ Table Grid7:V0tt 250Colorful List - Accent 11d^m$CJOJPJQJaJB'B -Comment ReferenceCJaJ<"< - Comment TextCJaJ:1: -Comment Text Char@j!"@ -Comment Subject5\F2QF -Comment Subject Char5\HbH - Balloon TextCJOJQJ^JaJNqN -Balloon Text CharCJOJQJ^JaJ44 gHeader  !6/6 g Header CharCJaJ4 @4 gFooter  !6/6 g Footer CharCJaJPK!K[Content_Types].xmlj0Eжr(΢]yl#!MB;BQޏaLSWyҟ^@ Lz]__CdR{`L=r85v&mQ뉑8ICX=H"Z=&JCjwA`.Â?U~YkG/̷x3%o3t\&@w!H'"v0PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!\theme/theme/theme1.xmlYOoE#F{o'NDuر i-q;N3' G$$DAč*iEP~wq4;{o?g^;N:$BR64Mvsi-@R4Œ mUb V*XX! cyg$w.Q "@oWL8*Bycjđ0蠦r,[LC9VbX*x_yuoBL͐u_. 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