Employment Requisition Form

EMPLOYMENT REQUISITION FORM

Requestor / Hiring Manager Information

Position Information

Position Title:   Location:

Requested Start Date:   Employment Type: Full-time Part-time Temporary/Contract

Business Justification and Job Summary

Required Qualifications, Education & Experience

Preferred Candidate Profile — Employment History (sample)

Employer 1 — Company: Title:
Dates Employed: From To

Employer 2 — Company: Title:
Dates Employed: From To

Compensation, Budget & Posting

Proposed Salary Range: From To   Budget Account Code:

Internal Posting: Yes   External Posting: Yes   Recruiter Assigned:

Candidate Screening & Legal Disclosures

At-Will Employment Statement: All hires made pursuant to this requisition will be subject to At-Will Employment unless a separate written agreement stating otherwise is executed and approved by authorized leadership. This requisition does not create an employment contract.

Equal Opportunity: The organization is an equal opportunity employer. Selection of candidates will be conducted in accordance with applicable equal employment opportunity laws and internal policies.

By submitting this requisition, the Requestor authorizes Human Resources to initiate background screening, reference checks, and verification of credentials for candidates who progress to the offer stage. Requestor must ensure appropriate candidate consent will be obtained at the time of application.

Initiate Background Check: Yes   Priority Clearance Required: Yes

Desired Candidate References (for recruiter use)

Reference 1 — Name: Phone:
Email: Relationship:

Reference 2 — Name: Phone:
Email: Relationship:

Reference 3 — Name: Phone:
Email: Relationship:

Hiring Approvals and Routing

Approved: Yes   Date:

Approved: Yes   Date:

HR Approved for Posting: Yes   Date:

Applicant Certification Language (for inclusion on posting / application)

Applicant Certification: I certify that all information I provide in any employment application or resume is true and complete. I understand that falsification or omission of material facts is grounds for denial of employment or immediate termination if hired.

Consent to Background and Reference Checks: By applying for this position, the applicant will be asked to provide consent to reference checks and background screenings consistent with applicable law.

Attachments & Recruitment Notes

Acknowledgment of Accuracy

I certify that the information provided on this requisition is accurate to the best of my knowledge, that the stated budget is available for this hire, and that I have obtained any necessary approvals to submit this request for recruitment.

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