Is training for the job opportunity required?
Yes
No
If yes, specify the number of months of training required: _________________________
Indicate the field(s)/name(s) of training required: __________________________________________________
Is employment experience required?
Yes
No
If yes, specify the number of months of experience: ______________________________
Indicate the occupation required: ______________________________________________________________
Special Requirements - List specific skills, licenses/certificates/certifications, and requirements of the job
opportunity: _______________________________________________________________________________
Place of Employment
Department Name: _________________________________________________________________________
Address: _________________________________________________________________________________
City: _______________________ County: _____________________ State: ______ Postal Code: ________
Will work be performed in multiple worksites with an area of intended employment or a location(s) other than the
address listed above?
Yes
No
If yes, identify the geographic place(s) of employment with as much specificity as possible. If necessary, submit
an attachment to continue and complete a listing of all anticipated worksite: _____________________________
_________________________________________________________________________________________
Department Signature: ___________________________________________ Date: ___________________
Dean’s Office Signature: __________________________________________ Date: ___________________