UNIVERSITY OF WEST GEORGIA Authorization
for Employment or Change of Status-Full Time
College/Division:_______________________________________
Department:____________________________________________
Applicant Name:________________________________________
Proposed Rank/Title: _________________________________ CIP Code_______________
Proposed Appointment Date: ___________________
Proposed Probationary Credit for Tenure: Amount ___________ Institution (s) __________________________
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
If yes, please specify retirement company____________________ Date of Retirement_______________
TRS Approved No Yes If yes, date of approval____________
Critical Hire Application Approved___________________
Relocation Funding Amount (if applicable)______________ Source of Funding for Relocation_______________________
Funding:
New Position
Replacement Position replacing ____ __________________________________
Budget:
Department__________________ Fund Code ___________ Position Number__________ Amount ________________
Proposed: E.F.T. _______________ Salary __________________
Funding Available: Yes No
__________________________________ ________________ ______________________________
Director of Budget and Research Date Comments
Summary Paragraph: To submit as recommendation to the Board of Regents include 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. If Part-time, please include the course(s) that will be taught.
____________________________________________________________________________________________________________
Approvals: Do Not Offer Conditional Employment or Change of Status until all approvals are obtained.
__________________________________________ ________________ _______________________________________
Department Chairman Date Comments
_______________________________________________ ___________________ ____________________________________________
Dean/Director Date Comments
_______________________________________________ ___________________ ___________________________________________
Vice President for Academic Affairs Date Comments
_______________________________________________ ___________________ ___________________________________________
President Date Comments
Revised February 2018
