Staff Request Form

Staff Request Form
Please complete all applicable
information prior to submittal
ACTION
☐ Create New Position* ☐ Extend Appointment ☐ Work Out of Class (WOC)
☐ Other, please specify:
☐ Fill Existing Vacant Position* ☐ Change FTE ☐ Reclassification/Reallocation*
*Attach position description, organization chart, and justification memo (if needed)
POSITION INFORMATION
Position Number Name of Current or Previous Incumbent (if applicable) FTE %
Classification/Proposed Classification Working Title Option Code (if applicable)
Division Office Location Proposed Start Date
Supervisor Name Supervisor Phone Number Proposed End Date (if applicable)
Bargaining Unit
Employment Conditions
☐ 206 AFSCME Clerical ☐ 217 Commissioner’s Plan ☐ Unlimited ☐ Temporary (up to 1 year)
☐ 207 AFSCME Technical ☐ 218 Non Unit ☐ Classified ☐ Temporary (up to 3 year)
☐ 214 MAPE ☐ 220 Managerial Plan ☐ Unclassified ☐ Temporary Unclassified
☐ 216 MMA ☐ 220 Excluded Administrator – Other: ☐ Emergency
(45 days or less)
Appointment
Status
Travel Required Work Schedule Hours of Work
Full Time ☐ No ☐ M ☐ T ☐ W ☐ Th ☐ F ☐ From:
Part Time ☐ Yes ☐ Sa ☐ Su ☐ To:
POSITION FUNDING
% %
Cost Center # Percentage Cost Center # Percentage
Cost Center # Percentage Cost Center # Percentage
5/2/13 Form A

Staff Request Form
Please complete all applicable
information prior to submittal
POSITION JUSTIFICATION
☐ Yes
☐ No
Is the position considered to be essential to reach department goals and the success of the division
as a whole? Please explain below:
☐ Yes
☐ No
Can this position be combined with any other position (or Campus Service Cooperative) to increase
efficiency of operations for the division and to contribute to the success of the system? Please
explain below:
REVIEWED & APPROVED (NOTE: Ensure all information is complete before signing this document)
Division Director/Supervisor Signature Date Division Cabinet Member Signature Date
Revised 05/02/12
5/2/13 Form A