REQUEST FOR EXEMPTION TO HIRING FREEZE

Agency/Department
	Company #
	Date
	
Job Class Title
	Job Class Code
	Position #
	
 % of General Fund

  % Other Funds	Date Position Vacant

	Reason for Vacancy

	
Level of Work (Select One)

Type of Work

			
How is work being performed now?

	(weekly cost)

		
Why is the Commissioner recommending the hiring freeze be waived?  Please address all alternatives considered for accomplishing the Agency’s mission without additional hiring.

	
Position Location                                       
	 How many other similar positions in this location?                  	
BUDGET OFFICE USE	
Comments

	
Signature

	Date

ADMINISTRATIVE & FINANCIAL SERVICES USE	
Comments

	
Signature

	Date

DEPARTMENT OR AGENCY HEAD USE	
Received	Comments

		
	Signature	Date	
PER 125c               11/04