Fillable CT HR 14 Duties Questionaire

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CT HR 14 Duties Questionaire

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State of Connecticut Human Resources
Duties Questionnaire Form
Form #. CT-HR-14
Revision Date: 10/2010
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
THIS QUESTIONNAIRE MUST BE RETURNED TO YOUR IMMEDIATE SUPERVISOR WITHIN SEVEN DAYS AFTER YOU RECEIVE IT.
YOUR NAME (PRINT) (Last) (First) (M. I.)
DEPARTMENT
TITLE OF YOUR JOB
RATE OF PAY
PER
NAME OF IMMEDIATE SUPERVISOR
TITLE OF SUPERVISOR
HOURS
WORKED
PER WEEK
NORMALLY:
1. DESCRIPTION OF DUTIES-
INSTRUCTIONS: In the space below, list all the duties of your regular job. The following suggestions will be helpful in preparing your list.
a. BE SPECIFIC – Try not to use general statements such as “Operate machines”, or “Handle correspondence”.
b. OMIT UNIMPORTANT DETAILS such as “pick up phone”, “Open files”, etc.
c. NUMBER EACH DUTY and start each duty with words which clearly show the type of action performed, such as
“Take dictation on letters, reports and forms.”
“Assign truck drivers and trucks on road projects for snow removal and sanding.”
“Assist, as requested, in routine work of the department such as simple posting or checking.”
d. LIST IN THE RIGHT HAND COLUMN the approximate percentage of time normally spent on each duty.
(Additional sheets may be attached if needed)
DUTIES
% OF TIME
How long have you been performing these duties?
CONTINUE ON PAGE 2
This form provided by the Department of Administrative Services
2. SUPERVISION
Workers in the following jobs are under my supervision.
Employee’s Date:
Signature: X
The Supervisor will make no changes or additions to the above.
All remarks by the Supervisor should be made below on this page.
1. IMPORTANT – Be sure to check the employee’s official current JOB TITLE on the top of the
first page of this questionnaire.
2. Is the employee’s description of his duties, and other answers, complete and correct and have
they been authorized by you as Supervisor? YES NO
3. If “NO”, what additions, deletions, corrections should be made?
SIGNATURE OF IMMEDIATE SUPERVISOR
X
TITLE OF IMMEDIATE SUPERVISOR DATE
I HAVE REVIEWED THE ABOVE STATEMENTS AND THE ABOVE SATEMENTS ARE CORRECT.
SIGNATURE, AGENCY HEAD / HR DESIGNEE DATE
X
This form provided by the Department of Administrative Services
JOB TITLE
NUMBER
REGULAR
OCCASIONAL
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CT HR 14 Duties Questionaire

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Completed 2 September 2020

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