DO NOT USE THIS DOCUMENT WITH	(Fillable form is located on the Washoe County
YOUR “SHOW PARAGRAPH MARKS” ON	Human Resources website)

Department / Division:
Request Type:
Requested Effective Date:	Click or tap to enter a date.
Is this an Off-Cycle Request?

OFF-CYCLE REQUESTS:

To determine eligibility for consideration of an off-cycle review, one or more of the following criteria must be met. Please check all that apply:

☐	The reclassification or new position request is directly associated with and supported by grant funding.
☐	The request entails a downward reclassification (lower pay grade than current classification).
☐	The reclassification or new position request is directly associated with a legal mandate.
☐	The request entails an equivalent level reclassification (same pay grade as current classification).

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Is the position Vacant?

If it is not vacant now but will be shortly, when?

Is there any fiscal impact associated with this request?

If yes, what do you anticipate the additional cost (or savings) to be, including all ancillary expenses:

Explanation of any legal mandates requiring the reclassification:

NEW POSITION REQUESTS

Please complete only one form for multiple requests of identical positions.

Please select one of the following. FTE% is required for any part-time, temporary or intermittent requests:

☐	Full-Time Position (Number of new positions being requested):

Full Time Equivalent (FTE) %: *Required for all Part-Time, Temporary & Intermittent Requests

☐	Part-Time Position (Hours per day/per week):

☐	Temporary Position

☐	Intermittent Hourly Position

If the requested position is identical to another in your department, please indicate that position # here:

Proposed Title for New Position Request:	Job Class #:

COST STRUCTURE/COST DISTRIBUTION (MUST BE COMPLETED)

☐ Check box if this is a reclassification and the cost distribution has not changed.
☐ Check box if this is a reclassification and the cost distribution has changed OR if this is a new position.
Indicate changes below

Current Cost Distribution:

Master Cost Center: Personnel Area: Personnel Subarea:

Cost Distribution
Cost Center/IO: % allotted: Cost Center/IO: % allotted:
Cost Center/IO: % allotted: Cost Center/IO: % allotted:
Cost Center/IO: % allotted: Cost Center/IO: % allotted:

New Cost Distribution:
Master Cost Center: Personnel Area: Personnel Subarea:

Cost Distribution
Cost Center/IO: % allotted: Cost Center/IO: % allotted:
Cost Center/IO: % allotted: Cost Center/IO: % allotted:
Cost Center/IO: % allotted: Cost Center/IO: % allotted:

JUSTIFICATION FOR REQUEST
1. Is this request the result of new duties being assigned?

Where did the new duties come from (i.e., new mandates, services, programs, other positions, etc.)?

Please briefly list the new duties:

What percentage of the job has changed (i.e., more than 40%)?

2.	What are the program impacts to be gained by this position, i.e. cost savings, productivity, service levels, new revenue, improvements, etc.? (This paragraph will be used in the BCC staff report so please be thorough and concise.):

3. What revenues/offsets will be used to support this position?

4. Are there other positions in the department performing similar functions?

If so, please list position numbers and assigned job classifications:

5. What alternatives to creating or reclassifying a position have you considered?

6. Does this position change the staffing configuration in this program/area?
7. Do you already have a workstation for this position:

If no, please identify the additional space needs:

8.	What amount has been requested for this position in the proposed budget?
What amount, if any, will be needed for ancillary costs?

POSITION INFORMATION

Is the position in question currently vacant?
Is the requested position identical to another in your department?

APPROVAL SIGNATURES

All signatures are required unless otherwise noted, and represent an acknowledgement that the requested position(s) will perform essentially all of the type and level of duties and responsibilities described in the attached Job Specification. I further certify the information provided in this document is accurate and complete.

*

Supervisor

Are the statements made in the employee’s section correct?

Please indicate any additions or exceptions.

Has this position acquired duties from other positions?

If yes, please identify duties, position titles and position numbers

Have any of the former duties of this position been reassigned to someone else?

If yes, which duties and who performs them now?

By adding my signature, I acknowledge that I reviewed this information with the employee, and to the best of my knowledge, assert it is a true, accurate and complete description of the employee’s job.

Supervisor Signature	Date

*

Department Head

By adding my signature, I acknowledge that I support this request, I have reviewed this information with the employee, and to the best of my knowledge, assert it is a true, accurate and complete description of the employee’s job.

Department Head Signature	Date

* Budget

By adding my signature, I acknowledge that I have reviewed and support this request for JEC submission.

Budget Signature	Date

*

Assistant County Manager

By adding my signature, I acknowledge that I have reviewed and support this request.

Assistant County Manager Signature	Date

In order to be accepted, this packet must be accompanied by the following documents. Please check off that you acknowledge this requirement and have attached or included them in your submission:
Current Organizational Chart (Please highlight positions that will be affected should this request be approved)	☐
Proposed Organizational Chart (Please highlight any changes from current org chart)	☐
Job Class Spec of the position being affected (For reclass of evaluation only) Specs located HERE	☐
Job Class Spec of the proposed new or reclassed position Specs located HERE	☐

I confirm this request has been reviewed with the department’s assigned Human Resources Analyst.	☐
If the request is for a technology related position, I confirm it has been reviewed with Technology Services.	☐