REQUEST FOR REAPPOINTMENT/*NOTICE OF REAPPOINTMENT FOR NON-SENATE ACADEMIC EMPLOYEES (NO STEP CHANGE)

*Once all approval signatures obtained; serves as notice of reappointment

REAPPOINTMENT PERCENTAGE INCREASE

REQUEST TO REAPPOINT BEYOND 24 MONTH LIMIT Junior Specialist only

DEPARTMENT: PREPARER NAME/PHONE:

EMPLOYEE LAST NAME: EMPLOYEE FIRST NAME:

EMAIL ADDRESS: NAME OF PI/SUPVR:

CURRENT TITLE/STEP: ORIGINAL START DATE:

TITLE CODE: CURRENT PERCENTAGE:

CURRENT EMPLOYMENT DATES: START DATE: END DATE:

PROPOSED REAPPOINTMENT DATES: START DATE: END DATE:

SALARY: OFF SCALE: (if applicable) TOTAL SALARY:

Is the percentage increase temporary? Yes No

PROPOSED PERCENTAGE INCREASE:

If YES, list Start/End Dates of temporary percentage increase: START DATE: END DATE:

Note: For temporary appointment increases, original appointment percentage will resume at __________ which will begin on _____________ until appointment ends on ____________.

Brief description of qualifications, position description, funding sources, etc. If requesting, an exception to the 24 month limit for Junior Specialists, please list reasons for justification. Attach a brief statement if needed.

SIGNED POSITION DESCRIPTION ATTACHED:

Chair’s Signature: Date:

PI/Supervisor’s Signature: Date:

DEAN’S DECISION

APPROVED: ________________________ DISAPPROVE: _______________________ Date: _____________

CANDIDATE’S ACTION o If your appointment has been in the same title or title series for a total of fewer than eight consecutive years, this appointment will terminate on the approved

end date without further action or notification. o If your appointment has been in the same title or title series for eight years or more at less than 50% appointment, this appointment will terminate on the

approved end date without further action or notification. o If your appointment has been in the same title or title series for eight years or more at 50% or greater, you are entitled to notice pursuant to APM 137-32.

PLEASE NOTE: In complicance with APM 137, your signature on this form serves as notice of your official terms of reappointment.

Candidate’s Acceptance: ____________________________ Date: ____________________

PLEASE NOTE: In compliance with the Immigration Reform and Control Act of 1986, individuals offered employment by the University of California are required to show specific documentation as proof of identity and of authorization to work in the United States. Please contact the department business office to complete the required paperwork for this appointment.

Once all signatures obtained, the department is required to send a copy of this form to the candidate, department manager, department chair, Dean’s Office, and Academic Affairs.