The following information will be used to request additional headcount for your department.  This form is to be used for full-time, part-time, temps anticipated for longer than two weeks and intern requests. 

Position Title:

Proposed Grade:

Department:

Division:

Supervisor:

Start Month:

____   F/T      ____ P/T  _____ hours per week  

____ Intern       ____ Winter/Spring        ____ Summer     ____ Fall/Winter

(Summer term will be budgeted for 37.5 hours/week; spring, fall and winter terms will be budgeted at 20 hours/week)

               ____ Undergrad        ____ Master’s            ____ PhD or Law

____ Temp (List start and end dates)  _____________________________________

Date Prepared:

POSITION SUMMARY 

What are the major responsibilities of this position?  Why does this job exist?  (Include 2-4 brief, clear, concise statements.) 

What major new work will be done with the addition of this new position?

Why won’t repurposing existing headcount work?

What is the return on investment that you expect to receive from this position?

How does this position fit in with [company name’s] mission and/or what impact does this position have on achieving [company name’s] goals and objectives? 

KNOWLEDGE/EXPERIENCE

What is the minimum level of education required for this position (i.e., Bachelor’s, Associate’s, 2-year technical degree)?

Experience in what area(s) would be necessary for this job (i.e., sales, accounting, marketing, customer service)?

In addition to a degree, how many years of experience does this job require? 

In lieu of a degree, how many years of experience does this job require? 

Skills:

What are the skills necessary for this position?

____    Oral and written communication skills:          ____ Good      ____ Excellent

____    Presentation skills:                                          ____ Good      ____ Excellent

____    Decision-making skills:                                   ____ Good      ____ Excellent

____    Problem-solving skills:                                    ____ Good      ____ Excellent

Ability to:        ____    Interact in a positive manner with internal contacts.

                        ____    Interact in a positive manner with external contacts.

                        ____    Understand verbal/written instructions.

                        ____    Complete tasks within critical deadlines.

                        ____    Maintain highest level of confidentiality.

____    Knowledge/ability to use various software programs (Windows, Outlook, Excel, Word, email, etc.). List software used: ______________________________________________________________________

____    Basic math skills.

____    Other.   

FINANCIAL

List the financial responsibilities of the position (i.e., signing authority, expenditures, contract authority, etc.).

 
SUPERVISION EXERCISED

Which of the following best describes what supervisory responsibility the position has?

____    No supervisory responsibility.

____    No direct supervisory responsibility, provides assistance to lower level employees.

____    Limited supervision, allocates and organizes work, provides guidance.

____    Direct supervision of at least one employee.

What position(s) does this position have direct responsibility for managing (including recruitment, selection, performance management)?

SALARY FOR THIS POSITION

Signatures

Hiring Manager:

Division Chief:

Executive Management Committee :

Please send this completed form to HR

For internal use only (Executive Management Committee)   

Date:   ______________________               

____  Approved               

____  Denied

REASON: