Request for Review of Job Information

The following form can be used as is or modified to suit your needs.

1. Reason for review of job information ________ new position _______ update/review requested
2. Incumbent's name	3. Department	4. Job Title	5. Title Code
6. Supervisor's name	7. Name of person who assigns work (if different from Box 6).
8. Directly supervises the following employees: Name Job Title		9. List positions reporting to employee's names in Box 8: Number of employees Job Titles
10. List any new or additional licenses, certificates, degrees or credentials that are required for the job:
11. List any new machines, tools, equipment, office appliances or motor vehicles which are now required to do the job. (Indicate whether use is occasional, frequent or constant):
12. List which responsibilities were added, deleted or changed since last review:
13. List which duties were added, deleted or changed since last review:
14. Indicate the areas where new or added skills or knowledge are now required:
15. Signature (Signatures indicate neither agreement nor disagreement with the re-classification/review requested).
Employee - I certify that the information on this form is correct and complete, and describes my job as I understand it. x _________________________________________ Signature Date		Immediate Supervisor - I have reviewed the statements on this form and certify to their accuracy. x ___________________________________ Signature Date

Last modified: April 7, 2008