Office of Human Resources
UNIVERSITY STAFF ADVISORY COUNCIL APPLICATION
The University Staff Advisory Council (USAC) provides a forum for exchanging ideas about the welfare and development of staff employees. The Council explores University policies and procedures that affect staff members and makes recommendations to the Senior Administration through the Vice President for Human Resources. Annual appointments to USAC are made in an effort to include a diverse representation of employees in exempt and nonexempt positions from a variety of University units and locations.
PLEASE NOTE: With the small number of voting members on USAC, there is a recommendation for only one individual per unit, college and/or campus (other than University Park) be represented. Ineligible Employees: Office of Human Resource employees serving as a Representative or Supervisor, Hershey Medical Center Employees (except the College of Medicine) and Technical Service Employees.
Date: ______Applicant name: ______
Exempt ______Nonexempt ______Job title: ______
Campus location: ______Years at Penn State: _____ Department: ______
Office address: ______Phone: ______E-mail: ______
Supervisor name: ______Title: ______E-mail: ______Phone: ______
Additional references (Penn State references only; please do not include your direct supervisor):
Name: ______Title: ______E-mail: ______Phone: ______
Name: ______Title: ______E-mail: ______Phone: ______
Please complete the following questions. (Attach an additional sheet if more space is needed.)
1. Please explain your interest in serving on the USAC.
2. Have you been/are you currently involved in any committee work or special projects at Penn State? If so, please describe them below and include the dates of when you were involved.
3. What qualities, skills, and/or special interests would you bring to USAC?
4. How did you hear about USAC? Penn State Today ___ USAC Web site ___ Referral ___ HR Rep ___ Other (please explain):
Supervisor Agreement Form
After reading the section below, please sign this form. Please have your supervisor sign this form as well, indicating his/her agreement with your possible involvement in USAC. Thank you.
______
Commitments of a USAC Member:
· USAC members serve a three-year term (July 1, 2016 – June 30, 2019.)
· USAC meets once a month for a two-hour meeting.
· Each USAC member is expected to serve on a sub-committee, which will meet as needed.
· Those USAC members serving as Committee Chairs may also be asked to attend executive meetings as needed, not to exceed one two-hour meeting per month.
I understand and agree to the commitments listed above.
Applicant: ______Date: ______
I fully support this applicant’s possible involvement in USAC, and would consider such activity as official University business.
Supervisor: ______Date: ______
Please send form to: Jeremy Warner, Membership Chair
302 Palmer Museum of Art
University Park, PA 16802
Email:
Phone: 814-863-5232
Applications must be returned no later than April 11, 2016.
Penn State is committed to affirmative action, equal opportunity, and the diversity of its workforce.
Revised January 23, 2015