APPENDIX B - TEMPORARY WORK ASSIGNMENT FORM

This form must be completed by an employee who has been assigned by his/her immediate supervisor to perform the duties of a higher rated position.

This form must be completed and submitted to your immediate supervisor no later than the tenth day of your performance of the higher rated position's duties.

__________________________________
Name of Employee

___________________________ mmm ___________________________
Employee Number mmmmmmmmmmmmmm Title of Present Position

___________________________ mm ___________________________
Title & Grade of Higher Rated Position mm Previous Incumbent of Position

___________________________ mmm ___________________________
Effective Date of Assignment mmmmmmmm Estimated Duration of Assignment

Reasons for Assignment _____________________________________________ ___________________________ mmm ___________________________
Signature of Employee mmmmmmmmmmm Date of Signature

___________________________ mmm ___________________________
Name and Signature of Immediate Supervisor mmmmmmmmmmmmmmm Date of Signature