Form 17 - Bor Recruitment/selection - University Of Hawaii
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University of Hawai‘i
BOR RECRUITMENT/SELECTION FORM 17
This form is required for all faculty, APT, and E/M appointments (except lecturers, casual hires, and cooperating
teachers/counselors). The data is used to prepare federally-mandated reports. Instructions are attached.
1.
Selectee's Name: _______________________________________________ Sex: _____ Ethnicity: _________________
Last
First
M.I.
Department: __________________________________________________________ Campus: _____________________
Position Title: ______________________________ Position No. ___________ Rank-Step/PR-Step: _______________
FTE: _________ Appointment Period: ___________________ to ___________________ Source of Funding: _______
For Community Colleges, indicate Job Group: _____________________________________________________________
2.
[ ] Faculty Position or [ ] APT Position or [ ] E/M (Executive/Managerial) Position
a) [ ] Temporary Appointment or [ ] Permanent Appointment
b) [ ] Tenure Track or [ ] Non Tenure Track or [ ] Tenureline Foreign Visa Status (faculty positions only)
c) [ ] New Hire; or if [ ] Transfer or [ ] Promotion, indicate below the position selectee is leaving:
Position Title: __________________________ Rank-Step/PR-Step: __________ Temporary ___ or Permanent ___
Agency/Department: ______________________________________________ Campus: _______________________
3.
[ ] Per A9.540, position is exempt from advertising or [ ] exception approved by campus EEO/AA officer (attach copy).
State reason(s): ______________________________________________________________________________________
_______________________________________________; then go to Section 7 for approval by Provost, Dean, or Director.
4.
Attach copy of ads from applicable recruiting sources (Ku ¯ Lama, statewide, national) with publication titles and dates cited
on the copy.
5.
Was there a screening committee or Department Personnel Committee? ___ Yes ___ No
No. of members: _______No. of female members: _______
No. of minority members: _______
6.
Total No. of Applicants: ________ Total No. of Female Applicants: _______
Total No. of Male Applicants: _______
No. Female Applicants: W ___ B ___ Hisp ___ NA ___ API: J ___ C ___ K ___ F ___ H/PH ___ S ___
I ___ O ___ (specify: ______________________________________________________________)
No. Male Applicants: W ___ B ___ Hisp ___ NA ___ API: J ___ C ___ K ___ F ___ H/PH ___ S ___
I ___ O ___ (specify: ______________________________________________________________)
7.
Are women or minorities underutilized (U**) for this position? If yes, specify group(s): __________________________
I have reviewed this action from an EEO/AA perspective and certify as follows (check if “yes”):
[ ] Recruiting sources were appropriate
[ ] Applicant pool was adequate
[ ] Selection was made on the basis of job-related criteria
[ ] EEO/AA status improved. Specify U** group(s): _______________________________________________________
The following affirmative action steps have been taken: _____________________________________________________
___________________________________________________________________________________________________
______________________________________ ____________________________________ _____________________
Signature of Reviewing Official
Print Name
Date
______________________________________ ____________________________________ ______________________
Signature of EEO/AA Designee (if applicable)
Print Name
Date
______________________________________ ____________________________________ _____________________
Signature of Provost, Dean, or Director
Print Name
Date
(if other than Reviewing Official)
UH EEO/AA Form 17 (revised 11/99)
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