Rev 12/09
APPLICATION FOR PREFERENTIAL STAFFING STATUS
T
o be completed by applicant
Name: College: _______________
Department: _________________________ Semester and year of hire in department:
Signature: ______________________________________________ Date submitted:
Applications must be submitted to the college HR office by the end of the second full week of classes for
consideration in scheduling for the next semester.
I
f you are applying for preferential staffing status in more than one department, you must submit a separate
application for each department.
If you already have preferential staffing status based on a previous evaluation, it is not necessary to reapply.
Your new evaluation will be reviewed to determine eligibility to maintain preferential staffing status.
To be completed by Department Review Team
Date of most recent evaluation (from Division or HR Office): ________________________________
S
ummary rating: ________________________
Meets evaluation criteria for preferential staffing status:
Yes ___
No ___
Disqualifying condition(s) for preferential staffing status: Yes ___ No ___
D
isqualifying condition(s) identified: _______________________________________________________
O
verride of disqualifying condition(s) due to extenuating circumstances: Yes ___ No ___
Preferential staffing status granted or maintained Date:
Preferential staffing status denied or not maintained Date:
Department Review Team:
D
epartment Chair: _______________________________________
Signature
Division Dean: ________________________________________
Signature
E
valuator (if applicable): ________________________________________
Signature
R
eturn completed original form to the college HR office. Copies to applicant and Division Office.
