REQUEST TO HIRE - WESTERN ENGINEERING
POSITION INFORMATION FORM
** For all Staff Positions **
Includes: All new positions, all contract extensions and temporary assignments, grant funded positions, student hires/paid co-op students, proctors,
research assistants/associates/engineers, PDAs.
Exceptions: Work-Bursary Students, PDFs, GRAs/GTAs, Adjuncts, Volunteers
General Information
Position/Job Title:
Department:
Supervisor:
Extension:
Email:
Why is this position available:
New Position
Contract Extension
Co-Op Student
Western Engineering Internship
Summer Student
Resignation/Transfer
Leave of Absence
Maternity/Parental Leave
Retirement
Termination
Replacement for LTD
Other:
Number of Openings Required:
_______________________________________________
Name of Employee Replacing:
If contract extension or if you have identified someone for the position:
Note: UWOSA Term positions may have end dates extended only twice to a max. of 24 mos.
Employee Name
and UWO ID# or Student #:
Employee Address:
Attach Valid Work Permit
(if applicable)
Start Date of Permit:
End Date of Permit:
Anticipated Start Date:
Anticipated End Date:
Length of Posting:
7 days (standard)
14 days
21 days
If you have identified someone for the position:
References on File
PAF Attached
Resume Attached
ENG-HR
References Attached
(At least 2 references
must be completed, including previous work supervisor.
Please attach copies.
Rev.01.16
Position Information
Employment Status:
Regular Continuing
Temporary / Term
Duration or new contract end date: _________________________
Hours:
Full Time (> 24 hours per week)
Part time (<= 24 hours per week)
hrs/wk
hrs/wk
{circle which applies}
Weekly or Monthly Paid:
Weekly (variable / standard)
(minimum wage is $11.25/hr plus vacation pay)
If paid weekly, hourly rate: $
If paid monthly, salary:
$
VACATION PAY: (Choose one)
Monthly (standard hours)
included in above salary
4% added to above salary
**NOTE: If you do not chose one of the above vacation pay selections, 4% will be added to the indicated salary**
Is this position Grant Funded:
Yes
No
Yes
No
Funding Agency:
$
Budgeted $ for Grant Funded position:
Has $ been allocated to cover notice and severance
obligations for this Grant Funded position if required?
%
%
SPEED CODE(S):
Work Environment
** mandatory that these fields be completed
Does this role require resources from the Department or Faculty?
Office Space
Laboratory Space
Other – Please identify
Where will the work of this role be performed? List all that apply:
SEB
CMLP
TEB
WindEEE
ICFAR
FPC
Identify the Room Locations (#'s):
Rationale for Recruitment/Extension
** mandatory that these fields be completed
Why is this position necessary? Please clearly identify the project/grant this role is supporting.
Educational requirements necessary for the role (minimum):
Please list 2 - 3 accountabilities of the role: (this will be included in the advertisement)
ENG-HR
Rev.01.16
Occupational Health & Safety Required (check all that apply):
Required for all Staff:
 WHMIS Comprehensive
 Employee Health and Safety Orientation - Work Safely at Western
 Workplace Hazard Communication Form (http://www.health.uwo.ca/services/workplace/index.html)
This form needs to be completed in collaboration with the supervisor and employee
 Accessibility for Ontarians with Disabilities Act (AODA)
 Safe Campus Community - Preventing Harassment, Violence, and Domestic Violence at Western
For those working in Laboratories:
 General Laboratory Safety and Hazardous Waste Management
Biosafety
Other Training (if required – check all that apply):
Laser Safety
X-Ray Safety
Radiation Safety
Ladder Safety
Fall Protection
List Other Required Training:
Required for all individuals who are supervising employees and students:
 Supervisors Health and Safety Training (Faculty-Supervisor Responsibilities)
Who should attend: Required for all University supervisors, principal investigators, administrative officers and managers
who must know and understand what their role, legal duties and responsibilities are, as a supervisor, with respect to
protecting the health and safety of those who report to them. (A supervisor is defined as a person who has control over the
workplace or authority over a worker.)
All information on these training modules and registration information can be found at:
http://uwo.ca/hr/learning/required/index.html
Secondary Supervisor (if applicable):
Will you be away at any point during this appointment?
Yes
No
If Yes, please list a secondary supervisor for the duration you are away and have them
sign below:
Secondary Supervisor:
Signature:
Signatures
Account Holder’s Signature (Supervisor)
Date
Account Holder’s Signature
Date
Department Chair’s Signature
Date
______________________________________________
Department Administrator Signature
ENG-HR
__________________________________________
Date
Rev.01.16
Dean’s Office Checklist:
Review Current Engineering Appointment (s) – PeopleSoft HR
Review Current UWO Appointment(s) – UWO-HR
Audit of Number of Hours Worked
Review Student Status – PeopleSoft HE
Review OH&S Training Status
Dean’s Office Signature
Date
For Dean’s Office Use ONLY
Post on Working At Western
Posting Number:
_______________________
YES
Posting Start Date:
_______________________
NO
Posting Closing Date: _______________________
If No, Why? _________________________________________________________________________
Comments:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
ENG-HR
Rev.01.16