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
Department Manager/Supervisor/Dean:________________________________________________ Date: _________________
Division Chief: ____________________
________
________________________________________ Date: _________________
Chief Financial Officer:__________ _______________________
_________
_______
___________
_ Date: _________________
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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