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FISK UNIVERSITY REQUEST FOR PERSONNEL ACTION

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Revised 2/2016
FISK UNIVERSITY
REQUEST FOR PERSONNEL ACTION
Date Prepared:
Prepared by:
Academic or Administrative Dept:
Please use this form to request all personnel actions. This request will be acted upon once it has been reviewed, with all necessary
signatures and approved by the Chief Financial Office and the President.
PERSONNEL CATEGORY
□ FACULTY Tenured Tenured-Track Not On-Track Adjunct Research
Tenure Review Date| From: To:
□ SENIOR ADMINISTRATOR □ MANAGER/DIRECTOR □ SKILLED CRAFT
□ TECHNICAL/PARAPROFESSIONAL □ SERVICE/MAINTENANCE
□ SUPPORT STAFF/OTHER PROFESSIONAL □ CLERICAL Union Non-Union
□ STUDENT WORKER (Non-Work Study) □GRADUATE STUDENT ASSISTANT
NAME: POSITION TITLE:
ACTION REQUIRED
□ Appointment □ Reappointment
□ Sabbatical □
Educational LOA
□ Medical LOA □
Reclassification
Aca Yr
Sem
CHECKED/REVIEWED/RECORDED BY FISCAL REPRESENTATIVE INITIAL
PLEASE ATTACH ALL RELEVANT DOCUMENTATION
♦ Action begin date: ♦ Action end date:
LINE ITEM IDENTIFICATION
♦ Name of the most recent employee on this line item #:
♦ Line item #: ♦ Salary on line:
♦ last rank/position assigned to this line item #:
CHECKED/REVIEWED/RECORDED BY FISCAL REPRESENTATIVE INITIAL
JUSTIFICATION
Explain why you are requesting this action. Consider all issues relevant to mission and goal of unit, strategic plans and resources.
CHECKED/REVIEWED/RECORDED BY FISCAL REPRESENTATIVE INITIAL
Revised 2/2016
COMPLETE ITEMS ON REVERSE SIDE
REVIEWED/APPROVED
SIGNATURES: DATES:
Initiator: Date:
APPOINTMENT/FUNDING INFORMATION
□ Line appt. ♦ Salary: □
24
pays
□ 20 pays □ Semester
□ Independent Contract ♦ Amount:
□ Hourly ♦ Rate:
FUNDING SOURCE TYPE & NUMBER
♦ E&G account #: ♦ Auxiliary account #:
♦ Grant account #:
CHECKED/REVIEWED/RECORDED BY
BUDGET ANALYST INITIAL AND/OR
GRANT ACCOUNTANT INITIAL AND/OR
TITLE III REPRESENTATIVE INITIAL
BUDGET CALCULATIONS/INFORMATION/NEEDS/AGREEMENTS
Consider all issues relevant to the unit’s budget
CHECKED/REVIEWED/RECORDED BY
BUDGET ANALYST INITIAL AND/OR
GRANT ACCOUNTANT INITIAL AND/OR
TITLE III REPRESENTATIVE INITIAL
(Only if an Administrative Department)
Supervisor: Date:
Vice President: Date:
(Only if an Academic Department)
Academic Dean: Date:
Provost: Date:
Vice President of Finance & CFO: Date:
Director of Human Resources: Date:
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FISK UNIVERSITY REQUEST FOR PERSONNEL ACTION

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Completed 23 July 2020

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