Personnel Requisition Form - Shasta College

Personnel Requisition FormThis form is required to fill a positionAdministrativeFacultyClassifiedPosition Title:Department:Starting Date:Requisition is for: New Position Additional Position Change of Position ReplacementFull Time Part Time % TemporaryVice President Approval Date:Funding Source:Cabinet Approval Date:For Classified Position: No. of Hours No. of MonthsRangeWork Assignment HoursIf a replacement: Name of employee being replaced and effective dateJustification for replacement/new position. How does it specifically support Student Learning, a Strategic Plan goal, or anoperational need? (Use additional sheet if necessary):Is substitute/temporary required during recruitment phase: Yes No(If yes, paperwork must be approved prior to starting work.)Screening Committee Members:Pursuant to Americans with Disabilities Act regulations and in order to accurately describe the position, please completethe Position Specification Sheet.Requested by:Approved:Approved:Approved:Approved:Supervisor/DirectorVice President – Academic Affairs or Student ServicesVice President – Administrative ServicesSuperintendent/PresidentAssociate Vice President – Human ResourcesDate:Date:Date:Date:Date:Action Plan Template – 06-09-2010Upon approval, a copy will be forwarded to the initiating Supervisor/Director

PERSONNEL REQUISITION FORMPOSITION SPECIFICATIONJob Title Report Time – Quitting Time Days of Week AssignedUnder the ADA regulations, it is required that the essential elements of the position be identified and used as a basis forconducting the recruitment and screening process prior to advertising a particular position. Using the job description asyour guidelines please identify the essential functions of this position.ESSENTIAL FUNCTIONS: Consider the important aspects of the job, the amount of time spent performing those tasks, thefrequency of performing them, and the consequences of error. What are the most important (essential) functions?Activity Total hours doing the activity Can it be modified?0 8Yes NoSitStandWalkBendSquatKneelClimbPush/PullUse Foot ControlsReach Above ShouldersHand ManipulationLiftintermittent continuous Total time continuousCan function be modified? yes noCarry intermittent continuous Total time continuousDescribe output/productivity requirements:Can function be modified? yes noList tools/equipment to be operated:Working Conditions:Exposure to dust yes no Exposure to noise yes no Exposure to chemicals yesnoMARGINAL FUNCTIONS: Please list those other tasks and assignments that this position might perform on a nonregular basisthat would involve less time, frequency and importance to the central functions of the overall job.MANAGERPERSONNEL OFFICER