OHR 100/Request to Fill
Revised: 06/23/14
State
Affiliated Corporation
Prepared by:
Comments/Funding Plan
Extension:
Date:
Eligible for Shift
Differential:
Yes
No
Shift Worked:
Benefits Eligible:
Yes
No
Reason Code
Type of Position:
Full-time
Part-time
% FTE
Appointment Date(s) from
to
University Support Staff
Unclassified
Exempt Non-Exempt
Exempt
Non-Exempt
Faculty
Professional Instruction
Length of
Appointment
Regular
Temporary
Temporary
No
9 month
Limited Term Regular
Probationary
Contingent
Less than .5
10 month
Temporary
Tenured
Provisional
.5 or more
12 month
Grade/Step:
Regular
Term (Other)
Hourly/Other Amt.
$
Executive
Org. No. Position No. Position Title FTE
Organization Name Supervisor / Organization Chair
Date to be Filled Previous / Present Employee / New Position
Proposed Funding Source(s): Proposed Salary or Hourly Wage (Unclassified):
GU $
RU $
$
GU Fund #:
RU Fund #:
Required Signatures:
Budget Review Officer:_____________________________________________________________ Date __________________
University Budget Director: _________________________________________________________ Date __________________
President/Vice President: ____________________________________________________________ Date __________________
BANNER APPROVED FUNDING – UNIV. BUDGET OFFICE ONLY
:FTE: _______ PClass: ______________ EClass: ______________
Fund Account Amount % FTE
Banner Forms Completed: POSN _____ PBUD _____
Budget Office Distribution: Human Resources – Original, Budget Officer – Canary, Budget Review Officer – Blue,
University Budget Office – Pink, President/Vice President – Tan, Payroll - Lilac
