Request for Release of Vacant Position(S)

FREEZE RELEASE – EXAMPLE for PROMOTION greater than 5%

REQUEST TO POST VACANT CRITICAL/NON-CRITICAL CARE POSITION(S)

AND/OR REQUEST FOR CRITICAL/NON-CRITICAL SALARY ACTION(S)

Division/Location: / DPH/Section/Branch/Unit (i.e. DPH/WCH/Immunization or DPH/ALCS/IT)
Print Contact Name: / Person completing the form or able to answer questions about it Phone:Area code and number
Date: / Today’s Date / Critical / Non-Critical / FundingSplit / e.g. 50% Fed/50% State
Available on OM 149 or from Budget Officer
Budget Code: / In most cases, this is 14430 / Center/Account Number: / Found on OM 149 report or from Budget Officer

ACTION REQUESTED:

Post and hire vacant position / Reallocation
Promotion / X / In-Range
Career Progression / Other:

POSITION INFORMATION:

Classification

BEACON Position No.

Date

Vacated

Budgeted Salary

Salary Grade

Position Comp Lvl

Current:NOT Working Title, actual Classification for the position the current State employee holds now

8-digit code beginning with 600 or 650 (if the State employee does not work for DPH, you may not have access to this number. In this case, leave this bland and HR will complete)

Get this figure from your Budget Officer. It is the BUDGETED Salary, not necessarily what the person is being paid.

Or CB for Career Banded

C, J, or A or NA for Graded Positions

Proposed NOT Working Title, actual Classification for the position you want to hire the person into

8-digit code beginning with 600 or 650 (This WILL be the same number as above)

SAME AS ABOVE

Or CB for Career Banded

C, J, or A or NA for Graded Positions

Current Salary

Proposed Salary

% Salary Increase Requested

Amount of Salary Reserve Needed

Employee’s Name & Pernr

or Name of New Hire

Employee’s current salary

Amount you would like to offer employee

Calculate the % of increase by dividing the proposed salary by the current salary and converting to a percentage

If the budgeted salary is less than the proposed salary, enter the difference here

Don’t forget to include the Employee’s Beacon # - this is not the position number, but the personnel number.

POSITION DESIGNATION:(To be completed by Human Resources)

SPA / Exempt Managerial / Exempt Policy-making / 115C
Delegated Class for proposed position / Non-Delegated Class for proposed position

Justification of request/reasons for filling and the impact on the organization if not filled. [For additional documentation, use reverse side or attach a second page.]This should be brief.This justification should focus on why it is warranted to give an increase due to an increase in the variety and scope of the position. Considerations of equity, length of time in the position, and performance are NOT justification for an in-range based on increased variety and scope, which is the only increase allowed at this time.

Signatures below indicate approval for the requested action

______

DivisionHR ManagerDate DHHS Human Resources Office Date

DivisionBudget OfficerDate DHHS Deputy/Assistant Secretary Date

Division DirectorDate DHHS Secretary Date

Form #101/9-2013

DHHS: 10/14/18