TO: OFFICE OF HUMAN RESOURCES
FROM: __________________________________________ DEPT: _______________________________ PHONE: _______________________
I. REQUEST FOR POSITION
Position Title: _________________________________________________________ Position ID: ___________________________________
Is this position new? Yes No • If no, position was last held by: __________________________________________________________
Position Class:
Faculty Administration Staff / Exempt Non-Exempt
Position Type:
Full-Time Part-Time Intern Temporary from ___________________ to _________________
Refer applicants to: __________________________________________________________ _______________________________________
Print Name/Title Email or Fax #
Position Duties: New Revised (Also send it electronically to H.R)
Requested Effective Date: Current Fiscal Year Next Fiscal Year Next Academic Year Other_______________________
FACULTY ONLY:
Rank: Assistant Associate Professor Instructor Visiting Resource Artist-in-Residence
Contract (academic year): Standard Fall/Spring (2 semesters) Fall/Spring/Summer (12 months) Semester: _____________
Tenure Status:
Tenure Track Non-Tenure Track Clinical
>> CONTINUE TO SECTION III, BUDGET INFORMATION <<
II. PERSONNEL ACTION (Check all boxes that apply)
New or Current Employee: _______________________________________________________________________________________
(Please print full name. If new, attach signed Employment Application & Background Authorization form)
Title/Position Change: Proposed new title ____________________________________________ (Attach new position description)
Position ID: ___________________
____________________________
_____
Employee Status Change: __________________________________________________ (e.g. FT to PT; PT to FT; Staff to Admin; Temp to FT, etc.)
Transfer between/within Campus Departments • New Department: __________________________________________________________
Salary Adjustment: _________________________________________________________________________________________________
Change to Budget Account #/Funding Source: ___________________________________________________________________________
Resignation or Separation from Employment (Attach letter of resignation) • Effective End Date:____________________________
Other: ___________________________________________________________________________________________________________
PROPOSED CHANGES FOR ABOVE (if applicable):
Effective Start Date: _________________________________ End Date: ________________________________
>> CONTINUE TO SECTION III, BUDGET INFORMATION <<
III. BUDGET INFORMATION
Proposed Salary: $_________________ • Account Number(s): ______% _____________________ / ____% ___________________________
Funding Source
(if Expenditure/Proposed Salary exceeds Budgeted Salary): Amt________________________ Acct_________________________
If grant, which benefits, if any, are to be included:____________________________________________________________________________________________
Physical Location (Building/Rm/Office Location): _________________________________________________Phone:______________________
Additional Employer Start-Up Costs
(desk, computer, etc.): ____________________________________________________________________
Accounting/Budget Approval: __________________________________________________________________ Date: _________________
SIGNATURES PRINT NAME SIGNATURE
Department Manager/Supervisor/Dean:_______________________________ ____________________________________ Date: __________
____________________
________
____ ____________________________________ Date: __________
________________________________
_________
_______
___________
_________ Date: __________
Division Chief:
AVP, Financial Management/CFO:
President
_
_______________________________ ____________________________________ Date: __________
FOR OFFICE OF HUMAN RESOURCES USE ONLY Action: _______________________________ Signature: ____________________________________ Date: ______________
Jacksonville University is an Equal Opportunity Employer
HUMAN RESOURCES ACTION FORM
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