Incumbent/Employee Name: Employee ID

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The supervisor of the position should complete and sign this form if you are submitting a PIQ or NC/FEAP job description form and you are anticipating an upgrade/reclassification and/or title or duties change and/or a salary/market increase for the incumbent and/or position. You do not need to submit this form or provide a justification if you consider this a position review with no changes; simply mark the appropriate box on the coversheet. Please note that the final decision on classification of the subject position will be made by the HR Classification Review committee.

Today’s Date:

Incumbent/Employee Name: Employee ID #:

(If vacant, mark “vacant”)

MAP Position Title and Number (e.g., Secretary.999):

Current Paygrade (if classified):

VP Area/Department/Unit:

Current Job Type: Classified Anticipated Job Type: No change

Non-classified Classified

FEAP Non-classified

FEAP

Position’s Supervisor/Title: EBO:

______

Briefly explain how this position has changed, giving concrete examples of the changes (please note that the PIQ/job description should more fully explain this information in detail):

When were the new duties assigned or the duty changes made (mo/day/year)?

(Please note that it is the supervisor’s responsibility to revise or rewrite a position PIQ/job description as soon as changes in duties/assignments are made; retroactive or “back pay” is not permitted by State law.)

Please note the position title and/or salary/paygrade you are anticipating for this submitted PIQ/job description:

Do you know of/are you aware of any other positions or employees assigned/performing work similar to that of this position in its new description? If so, please list position titles or names of incumbents:

My signature below attests that the above is true and accurate, to my knowledge:

Supervisor’s Signature: ______Date:

Departmental Approval: ______

(Name—please print) Signature Date

This form must be submitted by the EBO, along with the PIQ/job description, coversheet and resume (if applicable)