Form CS-107 (Rev 8/01)
REQUEST FOR APPROVAL OF UNDERFILL (STEP 1) AND
PROMOTION AFTER UNDERFILL (STEP 2) (RULE IV, SECTION 6)
INSTRUCTIONS: For STEP 1 (Request to Underfill) Complete STEP 1 section of form and submit copies to DER, Room 706, City
Hall. Upon DER approval, form will be returned to you. For STEP 2 (Request to promote after Approved Underfill) Complete STEP 2
section. Retain copy for your records. Return original to DER, Room 706, City Hall.
DEPT/DIVISION
DATE
LAST NAME
FIRST NAME
INITIAL
EMPLOYEE ID#
RACE
GENDER
AUTHORIZED POSITION TITLE
PAY RANGE/GRADE
PREVIOUS INCUMBENT
F&P APPVL. DATE
STEP 1: REQUEST TO UNDERFILL
POSTION TO BE UNDERFILLED AT:
TITLE
PAY RANGE GRADE
DOES YOUR DEPARTMENT HAVE AN AFFIRMITIVE ACTION GOAL FOR THIS POSITION? YES NO
PLEASE EXPLAIN WHY AND HOW THIS PARTICULAR PERSON WAS SELECTED FOR UNDERFILL?
OTHER PERSONS ELIGIBLE FOR THIS UNDERFILL:
TOTAL ELIGIBLE:
NO. OF MINORITIES
NO. OF FEMALES
IS THIS PERSON BEING CONSIDERED FOR APPOINTMENT RELATED BY BLOOD OR MARRIAGE TO A DIRECT SUPERVISOR? YES NO
IF YES , EXPLAIN RELATIONSHIP
IF APPROVED BY DER, WHAT CONDITIONS AND REQUIREMENTS MUST BE MET FOR PROMOTION TO THE FULL AUTHORIZED LEVEL:
EDUCATION:
WORK EXPERIENCE:
OTHER CONDITIONS:
APPOINTING OFFICER:
SIGNATURE
TITLE
DATE
PROSPECTIVE EMPLOYEE:
SIGNATURE
TITLE
DATE
APPROVING DER REPRESENATIVE
SIGNATURE TITLE
DATE
CURRENT, COMPARABLE OR HIGHER-LEVEL ELIGIBLE LIST(S) THAT THIS EMPLOYEE IS ON WHICH MAY SUPPORT THIS UNDERFILL
EXAMINATION TITLE(S)
ORIGINAL OR PROMTOTIONAL
DATE OF EXAMINATION
RANK ON LIST
RANK IN DEPT.
STEP 2: REQUEST TO PROMOTE AFTER APPROVED UNDERFILL
QUALIFICATIONS OF EMPLOYEE FOR PROMOTION TO
TITLE PR
EDUCATION:
WORK EXPERIENCE:
OTHER CONDITIONS:
REPORTING DEPT. OFFICER
SIGNATURE TITLE
DATE
APPROVING DEPT OFFICER
SIGNATURE TITLE
DATE
