<p> The University of North Carolina at Chapel Hill Office of Human Resources EMPLOYMENT OF RELATED PERSONS APPROVAL CERTIFICATE The Employment of Related Persons Certificate, formerly known as the Nepotism Certificate, is to notify you of a candidate being recommended for an appointment in the department who is related to another employee. This certificate also confirms the appointment will not result in a relative supervising or having any influence over the other relatives’ employment, salary administration or other related management, personnel considerations or in any other violation of the subject policy on employment of related persons. This certificate must be approved by the Assistant Director of Employment or Senior Director of Employment & Staffing prior to any employee assignment or employment offer. You must also submit a departmental organizational chart with your request or your request will be returned for completion. The department head or authorized representative must also approve this form. APPOINTMENT TYPE: SHRA EHRA Unpaid Volunteer, Intern or Visiting Scholar</p><p>PROPOSED PLACEMENT</p><p>Name: ______First Middle Last </p><p>Soc.Sec. Number: xxx-xx-______</p><p>Being Considered for: ______Position Number Classification Title Reports To: ______Print Name Classification Title Department: ______Number Name</p><p>DEPARTMENT CERTIFICATION (If related/affiliated to more than one employee, attach separate form.) The person proposed for placement listed above is closely affiliated or related to:</p><p>Name: ______First Middle Last</p><p>PID #: ______</p><p>Position: ______Position Number Classification Title</p><p>Relationship (specify): ______</p><p>Reports To: ______Print Name Classification Title</p><p>DEPARTMENT HEAD OR AUTHORIZED REPRESENTATIVE APPROVAL</p><p>I attest this selection will not result in a relative (or closely identified person) supervising or having any influence over the other relative’s employment, promotion, salary administration or other related management or personnel considerations, or in any violation of the subject policy.</p><p>______Name of Department Head or Authorized Department Representative Date</p><p>______Signature of the Department Head or Authorized Department Representative</p><p>For EHRA and SHRA Employees: Attach form to PeopleAdmin Hiring Proposal For Unpaid Volunteers, Interns and Visiting Scholars: Submit form via email to your assigned OHR Employment Consultant or via campus mail to OHR at 104 Airport Drive, CB#1045, Chapel Hill NC 27599</p><p>OFFICE OF HUMAN RESOURCES CERTIFICATION (to be completed by Employment & Staffing Department)</p><p>______Name of Assistant Director, Employment or Senior Director of Employment & Staffing Date</p><p>____ Rev. (12/09/2016) The University of North Carolina at Chapel Hill is an equal opportunity employer that welcomes all, including protected veterans and individuals with disabilities. Page 1 of 2 The University of North Carolina at Chapel Hill Office of Human Resources EMPLOYMENT OF RELATED PERSONS APPROVAL CERTIFICATE Signature of Assistant Director, Employment or Senior Director of Employment & Staffing </p><p>Rev. (12/09/2016) The University of North Carolina at Chapel Hill is an equal opportunity employer that welcomes all, including protected veterans and individuals with disabilities. Page 2 of 2</p>