Temporary Employment Job Order Form

Temporary Employment Job Order Form

This form should be completed in your Word program, NOT PRINTED. If you print the form, you will not have access to the “drop down” information.

Before starting to complete this form, please choose “Save As…” from the File Menu to save a new copy to your computer.

To better serve all State agency temporary employment needs, SOS will screen applicants based on submitted criteria (essential job duties and requirements). SOS staff will make all hiring decisions regarding SOS positions.

Agency information

Agency Name The Nebraska Department of Environmental QualityAgency # 84Div #

Business & Security Unit and Labor Distribution; these fields are REQUIRED

Home Business UnitHBU here

Security Business UnitSBU here

Labor DistributionLD here

Classification

Position Title Class Code # of FTE

Position and work specific

Work Location : Hourly Rate of Pay Salary Grade

Full- or Part-Time Full-TimePart-timeHrs/Wk 40 hours per week20 hours per weekOther (please specific in next field)Other 20-30

Work Hours 8:00 a.m. - 5:00 p.m. Flex * Start Date * End Date

* these fields are REQUIRED

(Temporary positions can only last for a maximum of 2080 hours. If you need an extension, you must notify SOS in writing prior to the posted end date.

Please be specific when listing the start and end dates for each temporary job, as this will be used to determine whether the employee will be offered health insurance benefits.)

Description of Essential Duties (please be as complete as necessary; there is no limit on the number of characters):

·

Education/Experience Requirements: (Please indicate if any driving on the job will be necessary, as we will need to run a check through Motor Vehicles and obtain a photocopy of the applicants’ valid driver’s license and proof of liability insurance).

·

Dress code for this position : Business Casual

The following information must be completed in full prior to filling any temporary position. (A one-time approval will be granted for seasonal Game & Parks Workers, temporary Revenue Workers, Highway Maintenance Workers/Laborers, as well as Direct Care Workers).

1)Type of TemporaryAgency (will be on your agency payroll)SOS Program (hired by DAS State Personnel)Outside service (outside State Government)

2)Has this position previously been filled on a temporary basis?YESNO

If Yes, please answer the following:

Was it within the previous 12 months?YESNO

What was the length of service of that appointment?3 months6 months9 months12 monthsOther (please specify in next field)Other

3)The reason this position is being filled on a temporary basis Short-term workload increase or special projectCurrently being advertised to fill permanentlyFill-in for permanent employee on leave statusFill a grant-funded position for up to one yearNo available FTEOther (please explain in next field)

Explanation

4)Will this temporary employee be filling a previously established, classified position?YESNO

If YES, what is the classification and the position number?

Supervisor’s Name Supervisor’s Phone Number

Agency Approval

This signature serves as verification that the listed duties and requirements accurately reflect those to be performed in this job; and the length of service time frame is a very close estimate of the amount of time temporary assistance will be needed in this assignment.

______

SignaturePhone NumberDate

DAS State Personnel Use Only

Approval is based on an evaluation of this request by the Director, DAS State Personnel Approved OR Denied

Explanation (if DENIED)______

______

DAS – State Personnel DivisionDate

SOS Use Only

Name of Person hired______SSN______

Start date______Type of hire SOS or Agency or Outside Service

Agency referral YES NO

Date modified: Thursday, November 14, 2002; 10:25 AMPage 1 of 2