1. (a) The Affidavit of Separation (Form F-5B) shall be used for reporting the date of and reason for the separation of a criminal justice officer from the employing agency. The date of separation shall be the date the criminal justice officer resigned or the date the employing agency terminated the employee. The Affidavit of Separation (Form F-5B) shall contain the following information:

   1. (1) separating agency;
   2. (2) separating officer, address, date of birth, position, date of final separation;
   3. (3) reason for separation;
   4. (4) name and signature of separating officer; and
   5. (5) name and signature of the employing agency's executive officer or authorized representative.
2. (b) An agency separating a person from employment or appointment as a criminal justice officer shall, not later than 10 days after separation, forward to the Commission a completed Affidavit of Separation.

History Note: Authority G.S. 17C‑6;
Eff. January 1, 1981;
Temporary Amendment Eff. January 1, 2001;
Amended Eff. October 1, 2018; August 1, 2002;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 25, 2019;
Amended Eff. May 1, 2025.