Revised 5/28/2015
Position: Date:
Part I – Position Information:
Dept.: Supervisor:
Status: FT PT (%) Contract Period: months/year
Type: Classified Administrative Faculty: FT-TT FT Temp Adjunct
Please check one: New Replacement for
Target Date Position Needed: ____ Account #
Position Grade Level: Salary Range: $ to $ per
In Current Year’s Budget: Salary $ /year Benefit Costs*: $ /year
If budget-neutral, please list account(s) to be charged:
Grant Funds Available for this position? No Yes If yes, please complete the following:
Grant Name: Period of Grant: _________
Funding Source: Amount: $ /
One-time (current year)?
Ongoing (next year)?
Justification for Position:
Please attach additional information as needed to explain how costs will be met, staffing plan, new needs being met, etc.
Recruitment (Pls. check one): Internal/COCC, only Local NW Region National*
Note: Candidates hired through a national search are eligible for a relocation reimbursement as provided by HR Policy 10.10.
Part II – Approval:
Dean’s/Director’s Signature Date
VP’s/Administrator’s Signature Date
Please attach updated job description to the requisition form and forward to HR by the last Thursday of the month to be taken to the
President for consideration at the first PAT meeting of the next month.
As requested As requested but with later start date:
On hold – may be approved at a later date
Not approved (May be reconsidered in next fiscal year’s budget)
President’s Signature Date
cc: HR (original)
Dean/Director and Hiring Manager
Fiscal Director
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