Employee Name:<Employee Legal Name they will sign as>

Employee #:

New Job Title:

Date Submitted:

Manager:

HR Representative:

Recommended Officer Level:

Executive Vice President Senior Vice President Vice President Assistant Vice President

Other: <Only complete if level is not listed>

Check Company(ies) for Which Title is being Requested:

Holding Company Parent / Reinsurance & Related Companies
Lincoln National Corporation / Lincoln National Reinsurance Company (Barbados) Limited
Insurance Companies / Lincoln Reinsurance Company of South Carolina
The Lincoln National Life Insurance Company / Lincoln Reinsurance Company of Vermont I
Lincoln Life & Annuity Company of New York / Lincoln Reinsurance Company of Vermont III
First Penn-Pacific Life Insurance Company / Lincoln Reinsurance Company of Vermont IV
Liberty Life Assurance Company of Boston / Lincoln Reinsurance Company of Vermont V
Broker Dealer Companies / Lincoln Reinsurance Company of Vermont VI
Lincoln Financial Distributors / Lincoln Reinsurance Company of Vermont VII
Lincoln Financial Distributors, Inc. / Lincoln Financial Reinsurance Company of Vermont
LFD Insurance Agency, Limited Liability Co. / Lincoln Financial Limited Liability Company I
Lincoln Financial Network / Miscellaneous Companies
Lincoln Financial Advisors Corporation / Jefferson-Pilot Investments, Inc.
LFA, Limited Liability Company / Lincoln Financial Group Trust Company, Inc.
LFA Management Corporation / Lincoln Investment Advisors Corporation
Lincoln Financial Securities Corporation / Lincoln Investment Management Company
JPSC Insurance Services, Inc. / Lincoln Investment Solutions, Inc.
California Fringe Benefit and Insurance Marketing Corporation / Lincoln National Management Corporation
Lincoln Retirement Services Company, LLC
Lincoln Variable Insurance Products Trust
Liberty Assignment Corporation
Westfield Assigned Benefits Company

*Disclaimer – The Company selections are provided per the direction of the Manager.

Advised:

Manager: / (Signature) Type your name here / Date:
HR Senior Vice President: / Type your name here / Date:
HR Compensation: / Type your name here / Date:

Instructions:

  1. Manager: Please contact HR Representative prior to completing this form. Prior to contacting HR Representative, please obtain approval of the officer nominee from the Business Unit Head and CLG Member.
  2. HR Representative: Please confirm that the Manager has obtained approval of the officer nominee from the Business Unit Head and CLG Member.
  3. HR Representative: Please refer to the Officer Nomination Process HR Representative Checklist on HRDirect. Once the form has been completed, electronically signed and dated by the Manager, please forward to HR Vice President.
  4. HR Vice President: Once review is conducted please update the checkbox, type name, provide date and forward back to HR Representative.
  5. HR Representative: Once review is conducted and all signatures are present as well as the Company(ies) candidate is being nominated for, please forward to HR Compensation along with the approved job description.
  6. HR Compensation: After final review please forward to and copy HR Representative listed on form.

Business Case Rationale for Non-Officer Level Nominations
<Include business case rationale here>

1737108_10Revised 9-19-2018