Job Request to Hire Form

JOB REQUEST TO HIRE FORM

Requesting Department & Hiring Manager

Hiring Manager:   Phone:   Email:

Position Information

Department/Cost Center:   Position Number (if existing):

Position Type: Full-time Part-time Temporary/Seasonal Contract

FTE (%):   Work Location:   Remote Option: On-site Hybrid Remote

Proposed Start Date:   Requested Posting Date:

Salary Range: From to   Proposed Hiring Rate:

New position created Replacement for departing employee Backfill due to internal transfer Temporary need Seasonal   Other:

Budget & Funding

Position Budgeted? Yes No   If no, explain funding source:

Recruitment Plan

Internal Posting: Yes No   External Posting: Yes No

Candidate Recommendation (Optional)

Candidate Phone:   Candidate Email:

Employment History (Provide at least two prior employers)

Title:   Dates Employed:

Title:   Dates Employed:

Education

Institution:   Graduation Date:

References (Provide three professional references)

Phone:   Email:   Relationship:

Phone:   Email:   Relationship:

Phone:   Email:   Relationship:

Legal Disclosures & Authorizations

At-Will Employment: Employment with the organization is at-will, meaning either the employee or the organization may terminate the employment relationship at any time, with or without cause or notice, unless a written agreement states otherwise.

Equal Opportunity: The organization is an equal opportunity employer. Hiring decisions are made without regard to protected characteristics as defined by applicable law.

Background and Reference Checks: By submitting this request, the hiring manager certifies that, upon selection, the candidate will be requested to provide consent for employment background checks and reference checks as required by policy.

Background check required for this position Drug screen required

Authorization to contact previous employers and references confirmed

Administrative Review (For routing — no signatures in this section)

HR Review Complete: Yes No   HR Reviewer Name:   Date Reviewed:

Budget Approval: Yes No   Approver Name:   Date:

Department Head Approval: Yes No   Department Head Name:   Date:

Hiring Manager Certification

I certify that the information contained in this request is complete and accurate to the best of my knowledge. I further certify that funds are available or funding has been identified for this position and that the recruitment plan described complies with organizational policies and applicable law. I acknowledge that employment is subject to successful completion of any required background checks, verifications, and required approvals prior to hire.

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