UNIVERSITY OF BALTIMORE
Agency Code 36 . 02 . 28
REQUEST TO HIRE CONTINGENT EMPLOYEE

PLEASE PRINT OR TYPE

Appointee: ______________________________________________     SSN:___________________________

Classification: _______________________________________   Position Status:  _______  New  _______ Continuing

First employment of Appointee at UB:  __________Yes    ___________No

Contract Effective Dates:   From _________________________     To  _________________________________

Est. work schedule:  Days per week: _______________     Hrs.per day _______     Hrs. per week __________

 _______________On Campus     _______________ Off Campus     Total Contract not to exceed: $ ______________

Department: _____________________________________________     Budget Number: ______________________

Supervisor: ______________________________________________     Phone #: ____________________________

Justification: Purpose and reason for requesting from outside source should be explained below:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - -

Approvals:   ________________________________________________________ __________________
                    Department Head                                                                                        Date
                   _________________________________________________________ __________________
                   Division Head or Dean                                                                                 Date
                   _________________________________________________________ __________________
                   Provost (Academic Affairs Appointments Only)                                            Date

Grant Funded Positions:  _____________________________________________ __________________
                                         Grants Officer                                                                        Date

Budgetary: ______________ __________________________________________ __________________
                   Fund                      Fiscal Officer                                                                  Date

HR: _____________________________________________ ________________
          Director of Human Resources                                                                                                        Date - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Additionally new hires require: Contingent Employee Agreement, Application, Immigration Verification (I-9), Drug Policy Acknowledged and Demographic Form.
REV. 9/9/98                                                                                                                                                          Original/HR - Yellow/Dept