Division of Academic Affairs

Request to Fill Position Form

This form should be completed by the departmental chairperson or administrative supervisor and forwarded to the next signatory. It applies to both full-time and part-time positions. There is no authorization to recruit in any manner until all signatories are obtained.

1.              Department:________________________________________             

2. Account #_________________________

3.           Title of position:____________________________________________________________________________________

4.           Type of appointment — check all that apply:

                ( )    fulltime                                                     ( )  management/confidential       

                ( )    part-time                                                  ( )  12 month

                ( )    term                                                        ( )  10 month

                ( )  temporary

5.           Anticipated starting date for position:_______________________________________________________________

6.           Anticipated termination date for position:___________________________________________________________

7.           Anticipated annual salary:_________________________________________________________________________

8.           This position is (check one and describe):

( ) New — specify funding source [account]:_________________________________________________________

 ( ) Replacement — indicate previous occupant:_______________________________________________________

9.           What are your Affirmative Action goals for this vacancy?




10.         What specific efforts will you make to realize the above goals?

The Search Committee members will identify potential candidates from underrepresented group data bases and other sources.  In addition to journal, web, and listserv advertising, they will use targeted mailings, personal phone calls to colleagues for recommendations and other best practices for developing a diverse pool.




11.   a.       Position description and qualification:




              b.      Copy of proposed contents of advertisement (attach)

              c.      Where do you plan to advertise?:

12.  Members of Search Committee (please indicate who the chair/convenor is with an asterisk):






_________________                                         ___________________________________________________________
     DATE                                                                                          (Submitted by)

_________________                             __________________________________________________________
     DATE                                                                                          (Finance Office)

_________________                                         ___________________________________________________________
     DATE                                                                                          (Dean)

_________________                                         ___________________________________________________________
     DATE                                                                                          (Vice President)

_________________                                         ___________________________________________________________
     DATE                                                                                          (Affirmative Action Officer)