Exemption Request Form printable pdf download

Exemption Request Form

UNIVERSITY OF NORTHERN COLORADO

EXEMPTION REQUEST FORM

Please complete this form in its entirety and attach the documents requested. An incomplete submission may cause delays

or be returned to you.

I. General Information

Agency or Department ___________________________ Position Title______________________________

Position Number ___________

Who does this position report to: (title only) ___________________________________________

Is this supervisor an officer of your institution? _____ Yes _____ No

II. Action Requested

Please check all that apply and attach all requested information.

___ Newly created position. Please include a copy of a current organizational chart and a detailed job description

Reconsideration – due to denial of a previous exemption request.

___

Re-exemption – change in job duties. Please include a copy of both the old and new job descriptions along with a

___

current organizational chart.

Re-exemption – job title change only. Please include a copy of the original exemption letter that you received from

___

the Department of Personnel.

Re-exemption – reporting relationship change. Please include a copy of a current organizational chart as well as a

___

copy of the organizational chart submitted with the original request.

Other, please

specify:___________________________________________________________________________________

__________________________________________________________________________________________

III. Guideline Requested

Please check the guideline this exemption applies to:

C.R.S. 24-50-135 (1)

Officers of an educational institution and their executive assistants; employees in professional positions,

___ (a.)

including the professional employees of a governing board; and any other employees involved in the direct

delivery of academic curriculum;

___ (f.) Professional officers and professional staff of the department of higher education, including the professional staff

members of any governing board of an institution of higher education.*

Updated 12/19/2011

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Exemption Request Form