Temporary Agency Staffing Request
Submit completed form with all authorizations to Human Resources
Department Information
Department
Contact Person
Contact Campus Phone
Contact Campus Fax
Contact E-mail
If the Agency Temp is filling in for a vacant position, indicate your recruiting plans. Check all that apply:
Search will be conducted.
Vacancy is posted. Provide Position Title:
Other: Specify:
Authorizations
Authorized Departmental Signature
Date
Title
VP Authorization
Date
Temporary Staffing Information
Title Requested (See Standards)
Anticipated Start Date
Anticipated End Date
Assignment Location
Room Number
Report To
Report to Phone
Reporting Hours (i.e. 8:30 AM - 5:00 PM)
Reporting Days (i.e. M-F)
Other
Job Duties
Special Skills Required
Human Resource Services Section
Date
Time
Agency
Start Date Temp's First Name Temp's Last Name
Photo ID Received
Date Received
Temp Request (REV 7/2017)
Comments/
Additional
Information:
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