PERSONNEL ACTION REQUEST
TO: Human Resources Office DATE:
FROM:
Administrative Head Signature/Date Appropriate Vice President Signature/Date
REQUEST TO FILL FACULTY/PROFESSIONAL POSITION
Title of vacant position Department
Previous Incumbent Last date of service
Requested appointment: Term Temporary Other
Obligation: Academic Year Calendar Year College Year Other
Full-Time Part-Time Percent of effort or hours per week
Salary range requested:
Appointment to begin (target) End date for Temporary
Recruitment: Full Search Search Waiver Request Attached Other (explain)
REQUEST TO FILL CLASSIFIED POSITION
Title of vacant position Department _______
________
Previous Incumbent Last date of service ________
Working hours: ________________________________________________ If part-time, hours per week _______________________________________
Appointment to begin (target) ____________ End date for Temporary ________
REQUEST TO RECLASSIFY POSITION
Present title and grade
Requested title and grade (attach new job description)
REQUEST FOR SALARY CHANGE
Employee Current Salary
New Salary (attach justification statement) Effective Date
TO BE COMPLETED BY HUMAN RESOURCES
PROFESSIONAL/FACULTY CLASSIFIED
Line Item Number Line Item Number
_________________________________________________
FTE FTE ____________________________________________________________
Budget Title Salary Grade_____________________________________________________
PR Grade (if applicable) Appointment Type:
Permanent Contingent Permanent Temporary
________________________________________________________
Human Resources Director
APPROVALS:
_________________________________________________________ ___________________________ ________________
_______________
Budget Officer Date Account Number Account Number
_________________
President Date
HR-1 (10/11)
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