Request for Release of Vacant Position(S)

FREEZE RELEASE

REQUEST TO POST VACANT CRITICAL/NON-CRITICAL CARE POSITION(S)

AND/OR REQUEST FOR CRITICAL/NON-CRITICAL SALARY ACTION(S)

Division/Location: / DPH/Section/Branch/Unit (i.e. DPH/WCH/Immunization or DPH/ALCS/IT)
Print Contact Name: / Person completing the form or able to answer questions about it Phone: Area code and number
Date: / Today’s Date / Critical / Non-Critical / Funding Split / e.g. 50% Fed/50% State
Budget Code: / Obtain from Budget Officer / Center/Account Number: / Obtain from Budget Officer

ACTION REQUESTED:

Post and hire vacant position / X / Reallocation
Promotion / In-Range
Career Progression / Other:

POSITION INFORMATION:

Classification

BEACON Position No.

Date

Vacated

Budgeted Salary

Salary Grade

Position Comp Lvl

Current: NOT Working Title, actual Classification

8-digit code beginning with 600 or 650

Obtain from Budget Officer

Or CB for Career Banded

C, J, or A or NA for Graded Positions

Proposed: Classification you believe the position should be

Same 8-digit code as above

Or CB for Career Banded

C, J, or A or NA for Graded Positions

Current Salary

Proposed Salary

% Salary Increase Requested

Amount of Salary Reserve Needed

Employee’s Name & Pernr

or Name of New Hire

Employee’s current salary if filled, NA if vacant

Recommended salary once reallocation is completed

% difference between employee’s current salary and proposed salary

$ amount needed to increase budgeted salary to the proposed level

If position is currently filled, include employee’s name AND personnel number (Beacon #)

POSITION DESIGNATION: (To be completed by Human Resources)

SPA / Exempt Managerial / Exempt Policy-making / 115C
Delegated Class for proposed position / Non-Delegated Class for proposed position

Justification of request/reasons for filling and the impact on the organization if not filled. [For additional documentation, use reverse side or attach a second page.]This should be brief. Any signatures or initials for program, branch, or section level approvals must be in this space – not below the statement “Signatures below indicate approval for the requested action” – those signature lines are ONLY for the identified approvers. Any documents with initials, signatures, etc, in this space will be returned to be revised and re-submitted.

ONLY THOSE INDICATED SHOULD SIGN OR INITIAL BELOW

Signatures below indicate approval for the requested action

______

Division HR Manager Date DHHS Human Resources Office Date

Division Budget Officer Date DHHS Deputy/Assistant Secretary Date

Division Director Date DHHS Secretary Date

Form #101/9-2013

DHHS: 12/31/13