Near Relative Request Form (Oct\15)
Requisition#: _________________________
Title: ________________________________
This candidate indicates a relative works at the University of California. Complete this form and return it to
Human Resources. Incomplete forms will be returned to the department.
Near Relative Candidate Information (individual to be hired)
Candidate Name:
Hiring Department:
Candidate's Supervisor (Name)
UC Employee Information (relative currently working at UCSD)
Name & Job Title:
Department:
UC Employee's Supervisor (Name)
Near Relative Candidate Justification
Family relationship to UC Employee (i.e. mom, dad, brother):
Will work in the same unit/department or VC area as the UC Employee?
Will report directly to the UC Employee or vice versa?
Will be on a reporting line over the UC Employee or vice versa?
Will have authority over salary, job duties, other work activities of the UC Employee or vice versa? (if Yes, Explain)
Will receive pay from a contract/grant the near relative created, is named on or responsible for or vice versa?
Will work in the same location or in close proximity to the UC Employee (i.e. same building, office, lab)?
Describe work environment and working group size?
List any unique qualifications the near relative candidate has for this position or additional information to support this
request:
I hereby acknowledge the information provided is accurate to the best of my knowledge. Any information found to be
inaccurate by Human Resources may result in a denial of this request or termination of the employee.
CONFIRMATION/APPROVALS
Request by:
Date:
VC Endorsement: (If requesting an exception to policy)
Date:
Chancellor Approval (If requesting an exception to policy)
Date: