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m a y b e s u b j e c t t o i n v e s t i g a t i o n / f u r t h e r v e r i f i c ation and that any misrepresentation or material omission may cause this request to be rejected. Submitted by:
Supervisor/Department Head/DeanDate:Approval Signature:
Appointing AuthorityDate:Associate Vice President for Finance
and Chief Financial Officer:Date:
FOR H.R. OFFICE USE ONLY
Employees Whose Salaries Must Be Adjusted
(Copy of current job description and application attached.)
Name and Personnel #
Job Title/Position#
Qualification/Credentials
Reviewed by:
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