Requestor: Date: : FTE: : : Full Time Part Time □ □ Per Diem Temporary □ □ : Proposed Date: Table/Grade & Salary JD Attached: Yes No □ □ Range: Pending □ : Responsible Executive: POSITION JUSTIFICATION : Decrease OT/Agency Utilization Quality □ □ Expansion/Increase in Clinical Volumes Expansion/Increase in non-clinical Volumes □ □ Insourcing/outsourcing Mission/Community □ □ Staffing Ratio Goals/Standard Regulatory/Physical Safety/Security □ □ Provide detailed justification for position approval as it related to categories selected :
Requestor: Date: : FTE: : : □ Full Time □ Part Time □ Per Diem □ Temporary : Proposed Date: Table/Grade & Salary Range: JD Attached: □ Yes □ No □ Pending : Responsible Executive: POSITION JUSTIFICATION : □ Decrease OT/Agency Utilization □ Expansion/Increase in Clinical Volumes □ Insourcing/outsourcing □ Staffing Ratio Goals/Standard □ Quality □ Expansion/Increase in non-clinical Volumes □ Mission/Community □ Regulatory/Physical Safety/Security Provide detailed justification for position approval as it related to categories selected :