Employment Requisition Request

I. DEPARTMENT REQUEST

1.Job Title Requested:       Title Code:     HR Representative:      Select OneJoe AraizaRoger WilbanksPaul JakewaysDiane SchmidtAnn SkinnerStacie KoltaiRuth Sinclair    Requisition Type: Select OneRecruitmentDirect HireAgency

2. Hire Type:                     Select OneAdditionRehireReplacement         Replacement For:

3. New Position is Budgeted   or Unbudgeted   No. of Openings:

4. Department:                        Cost Center:

5. Start Date(mm/dd/yy):     End Date(mm/dd/yy):    Shift: Select One1DaysEveningsNightsNon-SpecificVariableVariable     Appointment Type:       Select OneCareerLimitedPer Diem    Percentage of Time: Fixed   or Variable

Supervisor/Leader:             Supervisor Mail Code:   Extension:     Supervisor Email:

6. Employee Mail Code:    Employee Extension:

II. INFORMATION SYSTEMS ACCESS / TRAINING REQUIRED

PCIS Systems Admissions/Registration Order Entry PCIS Overview Ambulatory Care Systems IDX - Managed Care IDX - Scheduling Enterprise-Wide Scheduling Open Referrals TESWEB/EDITS Front Desk AVM EPIC Training	UCSD Ancillary Systems Pharmacy Laboratory Care Radiology/IDX Rad PACS Web 1000 IMPACS - Work Station Station Finance Invision	Other Systems INFOPAC ANSOS ORSOS AMS MELVYL HRS	Telecommunications Long Distance Access: Yes No (619/760) area only Continental USA International
PC Applications Other Software Microsoft Office Suite (specify below)	Electronic Mail System Outlook Web Access (OWA) Other E-Mail	Time Reporting/Status ATS ANSOS Timecard Exempt Non-Exempt Timekeeper	Voice Mail Yes No  Radio Pager Yes No
III. APPROVALS
Department Head:
Name of Approval Authority: Select OneAngela SciosciaAnn SkinnerBob HoganBrendan KremerDavid SakaiDeAnn MarshallDeborah WayneDennis GoodrichDennis MoranDuncan CampbellEd BabakanianJoe AraizaKathy BrewsterLeslie FranzLisa MurphyLori DonaldsonMargarita BaggettMona SonnensheinPaul CraigRich LiekwegScott HofferberShawn SheffieldSheila AntrumSMTTom JackiewiczTom McAfeeTrisha Lollo      Approved Date(mm/dd/yy):
Job Description / Recruitment Instructions: