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
          PROPOSED PLACEMENT
          Name:                             _____________________________________________________________________________
                                                           First                                                             Middle                                                       Last    
          Soc.Sec. Number:             xxx-  xx- ____________________
           
          Being Considered for:         ________________________________                    ______________________________________________________ 
                                                           Position Number                                                             Classification Title
          Reports To:                           _________________________________________________________________________________________________
                                                           Print Name                                                                     Classification Title
          Department:                   _____________________________                _________________________________________________
                                                         Number                                                                          Name
          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:
          Name:                              ________________________________________________________________________________________
                                        First                                                               Middle                                                      Last
          PID #:                                     __________________________________
          Position:                                 __________________________________                     ______________________________________________________
                                                          Position Number                                                               Classification Title
          Relationship (specify):            __________________________________
          Reports To:                            __________________________________________________________________________________________________
                                                          Print Name                                                                        Classification Title
          DEPARTMENT HEAD OR AUTHORIZED REPRESENTATIVE APPROVAL
          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.
          ________________________________________________________________   ________________________________________________________
            Name of Department Head or Authorized Department Representative          Date
                          
          ________________________________________________________________                   
          Signature of the Department Head or Authorized Department Representative
          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
          OFFICE OF HUMAN RESOURCES CERTIFICATION (to be completed by Employment & Staffing Department)
          _____________________________________________________________________              _______________________________________________
          Name of Assistant Director, Employment or Senior Director of Employment & Staffing                 Date
                                                                                                                                             ____ 
          Signature of Assistant Director, Employment or Senior Director of Employment & Staffing    
          Rev. (12/09/2016)           The University of North Carolina at Chapel Hill is an equal opportunity employer that   Page 1 of 1
                                          welcomes all, including protected veterans and individuals with disabilities.