OPM LOG Number 
 (FOR DEPARTMENT OF PERSONNEL USE)

POSITION ACTION REQUEST				

AUTHORIZATION  Number 
 (FOR DEPARTMENT OF PERSONNEL USE)

NEW JERSEY DEPARTMENT OF PERSONNEL

NOTE:  This request will be studied by the staff of the Office of Personnel Management only if accompanied by a Position Classification Questionnaire (DPF-44) and an organization charting showing 1)the location of the position within the agency structure and its relationship to other positions; 2) the title of the position to which the requested position will report; and 3) the number of positions and titles, if any, which will report to the requested position.

OFFICE OF PRSONNEL MANAGEMENT

APPOINTING AUTHORITY 
             Control Number

A.  TO BE COMPLETED BY REQUESTING AGENCY

INCOMPLETE REQUESTS WILL BE RETURNED

Division/Bureau

Department

Date

     
Position Number

Budgeted Title, Range, and Code

Requested Title, Range, and Code

     	
     	

     
Incumbent

     
Social Security Number

     
Requested Effective Date

     
Account Number (org/fund/prog/obj) required

     	
     	

     
B.  TYPE OF ACTION REQUESTED

1		Reclassification	a.  upward	b.  downward	c.  lateral	
2		New Position	a.  permanent	b.  temporary		
3		Abolish and Create				
4		Temporary Downgrade of Budgeted Level Position (RTI)	
5		Return to Budgeted Level of Position (RTP)	
6		Early Retirement Backfill	

C.  IF REQUEST INVOLVES A PROJECT SPECIALIST, PROJECT SUPPORT SPECIALIST, OR TENTATIVE TITLE POSITION, COMPLETE

 Extension of PS/PSS (give Authorization Number for original establishment)
     

Requested through date      	Tentative Title
(Requested New Title)
     	
	Suggested Bargaining Unit and 
Salary Range				Work 
		     			Week      	

D.  IF REQUEST INVOLVES A TEMPORARY SERVICES POSITION, PLEASE COMPLETE

Requested Salary Rates:
From $      		per         	   to 	$      	per      	

 NEW POSITION		 CHANGE IN RATE(S)	

E.  REQUESTING AGENCY COMMENTS (Attach additional sheets if necessary)

     	
I CERTIFY that this request has undergone management and fiscal review, and has been authorized by the agency.

Agency Representative
                        Approval  _____________________________________	Phone _______________________	Date _________________	

FOR DEPARTMENT OF PERSONNEL USE		PMIS TRANSACTION NUMBER	
Analyst
Signature 						     Date			

 DISAPPROVED – Reason 

_________________________________________________

_________________________________________________

DPF-44A REVISED FY2005

_________________________________________________		
 APPROVED
 Effective                       
 Date       ______________ thru ________________

Salary Rate or Bargaining Unit/Range

Work Week: