TEMPORARY EMPLOYEE REQUEST FORM

Departme

nt/College: ________________________ Date Requested: _______________________________

Prepared by: _______________________________ Contact Phone: ________________________________

Supervisor Name: ___________________________ Supervisor phone: ______________________________

Desired start date: __________________________ Approximate end date: __________________________

Pay range:_____________________________________ Hours per pay (bi-weekly): ___________________________

Anticipated work schedule (i.e. M-F, 8-5): _______________ Assignment location: (Building/Room

#): ________________________

REASON FOR REQUEST (select one):

Other (Please Explain): ________________________________________

WORK SKILLS REQUESTED (select all that apply):

Type of

Role: Skills Required:

1. 2. 1. 2. 3.

4. 5.

Specific skills required (please describe):

____________________________________________________________________________________________________________

Will this employee have contact with minors in this role?

If yes, please explain: __________________________

Summary of duties to be performed and/or special requirements. Must provide 5 or more specific duties.

I need the support of Talent Acquisition to recruit for this role. I have read the Temporary Employee Hiring Guide.

For Human Resources Use Only

Finalist Name: _______________________________ Start Date: ___________ Potential End Date: ___________

Pay Rate: _________________ Background check/PEBC Completed: __________________

IF TEMP AGENCY IS USED:

Agency Name: ______________________ Recruiter Name: ___________________ Bill Rate: _____________

Comments: ________________

(Select one)