UNIVERSITY OF WISCONSIN-STOUT
UNCLASSIFIED CATEGORY A ACADEMIC STAFF TITLE SURVEY
(Short Form)
For Category A Unclassified Positions
except Program Managers or Directors Unspecified
INSTRUCTIONS
1. Please look over the entire questionnaire before you begin. Each question should be answered
completely and accurately. If a question is not applicable, please write "does not apply". Title and salary
minimum may be determined in part by the information you provide.
2. If you have any problems in filling out the questionnaire, please contact Human Resources.
3. If you wish to make additional comments regarding the position, please use page 4 of the questionnaire.
Please feel free to attach any other information you feel would be useful in describing the position.
4. Please attach the following:
a. An organization chart, including reporting lines that show how this position fits into the work
unit.
b. A position description showing percents for each duty.
5. After cover sheet has been signed, please route titling survey to the Human Resources Office. Human
Resources will be contacting you regarding the appropriate title for the position. If you have any
questions, please contact the Human Resources Office.
Title
(to be assigned by Human Resources)
Office/Work Unit Name
Incumbent Name (if any)
Current Title (if any)
Working Title (if different)
Requested Title
Requested Working Title (if different)
Incumbent Signature (if applicable)
Title
Date
Supervisor Signature
Title
Date
Dean/Unit Director Signature
Title
Date
Division Administrator Signature
Title
Date
EDUCATION AND EXPERIENCE REQUIRED
Please remember when completing this section to identify the needs for the position if you were making a
new hire; do not simply reflect the education and experience of the incumbent.
1. What is the minimum level of formal job-related education necessary for an individual entering
this title? (Check one box)
Bachelor's Degree
Bachelor's Degree plus one year
required internship
Master's Degree
Law Degree/Second Master's
Doctorate Degree
Doctorate plus post-doctoral study or
Medical Doctor's Degree
Other Education (Please Describe)
2. If a degree is necessary, must special course work be completed or the degree be in a limited or
specific field? (Please describe and give reasons why it is necessary.)
3. Is a federal/state/local license or professional certification required of a person holding this title?
(Please describe and give reasons why it is required.)
4. What is the minimum relevant work experience required to prepare a person to enter this title?
5. Years in present title:
Years of related experience:
Category A - Page 2
SUPERVISORY RESPONSIBILITITES
If the incumbent has the authority to supervise employees
either directly or through subordinates, please enter the FTE
supervised in the appropriate columns. (Do not duplicate FTE,
but enter on the row of the highest lest of supervision.)
Unclassified
Staff
Classified
Staff
Student,
Volunteer or
LTE
FTE
FTE
FTE
Responsible for all day-to-day personnel decisions including
final decisions to hire, terminate, promote and set salaries.
Direct the work of staff and conduct formal performance
appraisals and yield substantial influence in hiring,
terminations, promotions and salary decisions.
Assign and review work and/or act as a group leader on a
continuing basis.
PROGRAM AND BUDGET MANAGEMENT
What are the major on-going program areas that
the incumbent personally directs?
What are the major on-going program areas (if
any) that the incumbent directs through others?
(Please list each separate program and the title
of the person responsible.)
Does the incumbent monitor or control
expenses, generate revenue, and/or develop and
administer budgets?
No
Yes
If yes, please describe your financial responsibilities and the
annual dollars for each program/unit involved. (If additional
space is needed, attach a separate sheet.)
Category A - Page 3
SUPERVISOR'S COMMENT SECTION
It is important that you, the supervisor, review the questionnaire, since you may have a different perspective of
the position being described (if it is being used for the purpose of reviewing title). Please remember that this
questionnaire is intended solely for the purpose of assigning an appropriate title to the position in question. The
information provided on the previous pages is not to be used for purposes of evaluating an individual's
performance nor should comments be addressed to this subject.
ACTION OF HUMAN RESOURCES
Prefix/Title Assigned:
(Prefix)
(Title)
Effective Date of Title Change:
Signed:
Date:
(Director of Human Resources or Designee)
NOTE: a member of the Human Resources staff will notify the applicant of the decision. If approval has been
DENIED or the academic staff employee and/or supervisor(s) disagree with the decision of the Human
Resources office, an appeal process may be initiated.
Category A - Page 4