TEMPORARY APPOINTMENT REQUEST FORM

Please note required fields are marked with an asterisk (*)

Dept. & Position Information
*	Supervisor Name:
*	Supervisor Phone Number:
*	Department:	Business Office Forest Management Communications Group Computing Helpdesk Dean's Office Forest Engineering Forest Resources Forest Science Maintenance & Purchasing Forestry Media Center Oregon Forest Education Program Outreach Education Office Student Services Wood Science & Engineering
	Position Title (if known):
*	Job Location - City, State:
*	Job Location - Site:	Peavy/Richardson  FSL  Remote Site (Off Campus)  Other     Please specify:   Please Note: Temporary Employees are not eligible for Telecommuting Arrangements
*	Number of Positions:
*	Position Summary:	Why does this position exist?
*	Specific Duties:
*	Decision Making/Guidelines:	Breadth & scope of decisions; level of autonomy/authority.
*	Lead Work/Supervisory Responsibilities: Does this position have any Lead or Supervisory responsibilities?	No    Yes    * Please select all that apply: Plans Work Assigns Work Approves Work Disciplines/Rewards Responds to Grievances Hires/Fires (or effectively recommends) Prepares/signs performance evaluations/reviews * How many employees does this position provide lead work for, or directly supervise? * What percentage of time does this position perform lead work/supervisory duties?
*	Is a Valid Driver's License Required for this Position:	No   Yes
*	Start Date:
*	End Date: (Not to exceed 6 months total.)
*	Approximate Number of Hours Per Week:
*	Index to Charge:
	Activity Code
*	Rate of Pay:
	Employee Name(s) if known:
*	Employee OSU ID(s) or SSN:
*	Reason for Appointment:	Emergency, non-recurring or short-term workload need To replace a regular employee on leave * Describe the circumstances necessitating this emergency, short-term, non-recurring work assignment:
Safety/Working Conditions
*	Operate a University vehicle:	No   Yes    * Please select all that apply: Passenger Vehicle Tractor ATV/Golf/Utility Cart Forklift Heavy Machinery Mower Agricultural Machinery Other
*	Operate a Boat/Vessel:	No   Yes
*	Enter Restricted Areas:	No   Yes    * Please select all that apply: Confined Spaces Radioactive Materials Location Biological Laboratories Carcinogen Laboratories Laser Facilities UV Facilities Magnetic Fields (NMR, etc.) X-ray Facilities Construction Other
*	Work with chemicals in a non-lab setting:	No   Yes
*	Work with lift equipment:	No   Yes
*	Work with hazardous material or equipment:	No   Yes    * Please select all that apply: Toxic Chemicals Radioactive Materials or Instruments Carcinogens Biological Agents Human Body Fluids Compressed or Cryogenic Gases Controlled Substances (Drugs) Lasers X-Ray Machines Other
*	Work on elevated surfaces:	No   Yes
*	Perform hot work with metal:	No   Yes
*	Work in or over water, or while underway: (e.g. scuba dive, free dive, operator/passenger in boat, lifeguard, water sampling, etc.)	No   Yes
*	Use power tools:	No   Yes    * Please select all that apply: Pneumatic Driven Tools Gasoline Driven Tools Electric Tools Stationary Shop Tools
*	May be exposed to high noise levels:	No   Yes
*	Perform paint or paint preparation:	No   Yes
*	Work in speciality operations area:	No   Yes    * Please select all that apply: Forestry Operations Health Care Environment Ag Chemical Application (pesticides, herbicide) Respirator or Dust Mask use Food Service (prep, washing, dishes, etc.) Work With Small Animals Work With Large Animals
*	Work in a laboratory:	No   Yes
*	Work in an office:	No   Yes
*	Lift Objects:	No   Yes    * Please describe the objects and the weight:
*	Carry Objects:	No   Yes    * Please describe the objects and the weight:
*	Push/pull Objects:	No   Yes    * Please describe the objects and the weight:
	Comments:
			Please double-check the form and include information for all required fields.