*Please Include (Where Applicable) MOS Dashboard Data, Claim Count Totals, Floater

Temporary Worker Requisition Form Completed by Hiring Manager *Any forms submitted incomplete will not be reviewed; the form will be returned for your completion which could result in delayed recruiting.

Job Title:

Direct Reports to Name: Dept #: Physical Office Location: Budgeted: Yes No Today’s Date: Target Start Date: Scheduled Weekly 37.5 hours Hours 40 hours Duration: Select One*

Reason for Position: Select One If replacement, Previous Incumbent: Previous Incumbent Salary:

Budgeted Salary:

Further Justification:

*Please include (where applicable) MOS Dashboard Data, claim count totals, floater availability, etc

Please provide specific details or nuances that should be included in the advertising of this position. (Ex: bilingual, specific license or certifications, if candidate already in mind)

Recruiting Team: Designated contact person and/or group of contacts who will receive and review resumes. (Ex: This individual/individuals will be forwarded possible candidates and provide feedback to HR. They will also have access to the open position in OpenHire)

Form Submitted By: Title

Please Email the completed form to [email protected] This requisition form will be submitted for approval and a recruiter will contact you to discuss recruitment strategy.

Position Requisition Form Revised: 12/2013