PDQ

Who is completing this request? *

	Employee
	Supervisor

EMPLOYEE Basic Information:

Employee Name: *

Employee Department:

Employee's Current Job Title:

Employee's Current Grade:

Employee's Current Pay Rate: *

Date Hired into Current Position

Reviewer Information:

Select your department from the list provided to determine to whom the form will be routed.

Department: *

Decision Maker Name

Decision Maker Email

HR Generalist Name

HR Generalist Email

Supervisor Name:

Supervisor Email:

Reason for Reclassification Request: *

	Newly assigned duties/tasks/activities
	Duties/Tasks/Activities have changed over time and/or unsure if the job is appropriately classified.

List all new duties/tasks/activities assigned to this employee. DO NOT copy from the job description; the list should describe specific duties/tasks/activities. *

List job duties removed from this employee (if applicable). *

List ALL job duties/tasks/activities completed by the employee by the percentage of time spent.

The total of all percentages must account for 100% of the position's time.

DO NOT copy from the job description; the list should describe specific duties/tasks/activities. The request will be returned if duties are copied from the job description.

Percentage	Daily (approx.)	Weekly	Monthly	Quarterly	Annually
5%	1/2 hour	2 hours	1 day	3 days	2 1/2 weeks
10%	1 hour	4 hours	2 days	6 1/2 days	5 weeks
15%	1 1/2 hours	6 hours	3 1/2 days	10 days	8 weeks
20%	2 hours	8 hours	4 1/2 days	13 days	10 weeks
25%	2 1/2 hours	10 hours	5 1/2 days	16 days	13 weeks

Percentage of Time	Job Responsibility
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Percent of work total

Percentage of work must total 100%.

Provide any other information relevant to this reclassification request.

Signature *

Undo

signature

I agree/disagree with the information provided.

	Agree
	Disagree

Comments:

Supervisor's Signature

Undo

signature

I agree/disagree with the information provided.

	Agree
	Disagree

I support HR's review of this reclassification and confirm that there is budget/funding to support a pay change (if applicable) resulting from the reclassification. Denying this request will close it out and require a new submission. If you believe information is missing, please contact the employee or supervisor to discuss then add notes in comments.

	Approve
	Deny

I have reviewed any potential equity concerns associated with the proposed reclassification.

	Agree
	Disagree

Comments:

Decision Maker's Signature:

Undo

signature

Submit

	Applies basic skills and procedures appropriate for the position within assigned functional area.
	Beginning advanced skills and understanding of the specified area.
	Some advanced skills and knowledge. Thorough understanding of the total specified area.
	Advanced skills and knowledge for one or more specified areas. Expert in the specified area.
	Broad knowledge about a wide range of areas. Advanced understanding of specified area and the ability to resolve complex issues i.e expert.

	Duties and tasks are simple and repetitive. Follows existing policies, practices, and procedures. Refers questions and problems to higher levels.
	Duties and tasks are varied but standardized. Works on assignments that are semi-routine in nature where ability to recognize deviation from accepted practice is required.
	Works on assignments that are moderately complex in nature where judgement is required in resolving problems and making recommendations.
	Works on assignments that are complex in nature where considerable judgement and initiative are required in resolving problems and making recommendations.
	Duties and tasks reflect substantial variety and complexity. Requires extensive knowledge in multiple functions. Is the resource to others in the resolution of complex problems and issues.

	Unsure
	No Change in Title
	New Job Title/Description Required
	Select from Existing Job Title

	Yes
	No

	Regular/Limited Term
	Temporary/Seasonal
	Volunteers/Interns

	Yes
	No
	Unsure

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