DLEG Office of Human Resources
LARA Office of Human Resources Revised 9/27/18
Temporary Service Request
Date received:
|1. Assignment Dates | | |Record #: |T- |
| |New Request |Begin date: | |End date: | |
| |Temp Agency: |Kelly Services |Temp Employee requested, if any? | |
| |Extension Request |Temp. name: | |New end date: | |
| | |
|2. Position Requested | | | |
|Job class/level: | |Work hours: | |
|Supervisor: | |Phone #: | |
|Justification: | |
|Employee name & class of position filling in for: | |
|Expected date of perm. employee’s return: | |
|If vacancy, what steps are being taken to fill | |
|position? Date requisition submitted. | |
|If no vacancy, can a temporary/ permanent position be | |
|established/ filled through the classified service? | |
|If no, why not? | |
|Specific job duties: | |
|Necessary skills & experience needed to perform job | |
|duties: | |
| | |
|3. Location | | | |
|Bureau/Office/Comm.: | |Division: | |
|Building: | |Address: | |
|County: | |Nearest crossroads: | |
|Parking: | |Dress code: | |
|Contact Person: | |Phone #: | |
|*LARA Finance review: | |SIGMA Home Unit: | |
|SIGMA Acct Template # | | | |
|SIGMA Accounting Profile (if any):| |County: | |
|Shipping Location Code: | | | |
|4. Approval |Date Approved |Signature |
|Bureau/Office/Comm.: | | |
|HR Office: | | |
|HR Director: | | |
| |
|5. OHR | |
|Temp Reporting: | |DO#: |
|Start date: | |Billing rate: |
|Temp Agency: | | |
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