UNIVERSITY OF WEST GEORGIA
Authorization for Employment or Change of Status (Full-Time)
Department:_College/Division:_________________________ ___________________________________________
Applicant Name:________________________________________
CIP CodeProposed Rank/Title: _________________________________ _______________
Proposed Appointment Date: ____________________
Proposed Probationary Credit for Tenure:
Institution (s) Amount ___________ _____________________________
Agreement Regarding Completion of Degrees: ________________________________________________________
Applicant:
Is Related to a Current University of West Georgia Employee Yes No
Is Conversant in English Yes No
Highest Degree Has Been Verified Yes No
Retired from the University System of Georgia Yes No
Date of RetirementIf yes, please specify retirement company____________________ _______________
TRS Approved No Yes If yes, date of approval____________
Critical Hire Application Approved___________________
Source of Funding for RelocationRelocation Funding Amount (if applicable)______________ _______________________
____________Funding: New Position Replacement Position replacing:____ ______________________
Proposed: E.F.T. ____ Position Number__________ Home Department__________________ Fund Code ___________
Salary __________________ Reviewed by Provost Budget________________________
Funding Available: Yes No
________________ __________________________________ ______________________________
Budget Services Date Comments
Summary Paragraph: Education: Degrees, Major, Institutions, Dates; Experience; Additional Comments: Recommendations,
Special qualifications (required if applicant has less than 18 credit hours graduate work in teaching field); use reverse if needed.
____________________________________________________________________________________________________________
Approvals: Do Not Offer Conditional Employment or Change of Status until all approvals are obtained.
__________________________________________ ________________ _______________________________________
Department Chair Date Comments
_______________________________________________ ___________________ ____________________________________________
Dean/Director Date Comments
_______________________________________________ ___________________ ___________________________________________
Provost and Vice President for Academic Affairs Date Comments
Revised April 2018