Form Ccf-168 - Position Control Authorization Form
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29998-500168
CCF-168
Rev. 9/03
CLARK COUNTY SCHOOL DISTRICT
Position Control
Date Received
POSITION CONTROL AUTHORIZATION FORM
Authorization
in Personnel:
(PERSONNEL REQUISITION)
Yes
No
Date:____/____/____
Date of Requisition: _______ / ______ / ______ Effective or Start Date: ______ / ______ / ______
Initials:______
SECTION I
COMPLETE THE FOLLOWING
School/Department With Vacancy: ___________________________________________________________ Location Code: _____________________________
Position: ______________________________________________________ Program: ____________________________________________________________
(If Teacher, Specify Grade Level(s) and Subject(s) Taught)
Check One:
Support Staff
Licensed
Administrative
Date needed: ________________________________
Unique requirements needed to fulfill job responsibilities, i.e., languages spoken, extra assignments, etc.:
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Contact person: ________________________________________ Phone: _________________________ Title: _______________________________________
SECTION II
COMPLETE ONE OF THE FOLLOWING AREAS
Area A
Replacement for: ____________________________________________________________________ Sex/Ethnic:____/____ Date Leaving:____/____/____
Reason __________________________________________________________________________________________________________________________
Permanent Replacement/Regular Status
Temporary Replacement Job Stop Date ____/____/____
Area B
New Position
Rationale: _____________________________________________________________________________________________________
Earned by Formula
Outside Formula, but included in budget (See CCSD Policy 4120)
Area C
Teacher recommended: _________________________________________________________ S.S.# _______________________________________
Extra Instruction (teachers Only)
Days of Week:
Track
Grading Period/Semester
Trimester
Prep in Lieu/Purchase of Prep
Adaptive PE
Monday
1
1st
1st
Extended Day
Adult Education
Tuesday
2
2nd
2nd
ESL
Credit Deficient
Wednesday
3
3rd
3rd
Other __________________ (specify)
Instructional Clinic
Thursday
4
4th
Friday
5
Start date: _______________ Stop date: ________________
Rate of pay:
Contract hourly
$22.00 per hour
I have read the standard agreement on the back of this form for providing extra instruction. (Copy must be maintained in the principal's office.)
Teacher's Signature: ______________________________________________________________________ Date: ___________________________________
Area D
Person recommended: _________________________________________________________ S.S.# _______________________________________
Change in Hours
Change in Months
Change in Funding
Increase from _______ to _______
Increase from
_______ to _______
Other ___________________ specify)
Decrease from _______ to _______
Decrease from _______ to _______
Rationale:_______________________
SECTION III
PLEASE CHECK TO SEE THAT ALL CODES ARE CORRECT
Work Loc. __________ Variance Loc. ___________ Check Dist. Loc. ____________ Eval. Dist. ____________ Months _________ Days _________
1. Fund______ Unit______ Account_______ Object______ Fiscal Yr.____ Project________ Grant________ % of fund______ Min._____/Hours_____Per Day
2. Fund______ Unit______ Account_______ Object______ Fiscal Yr.____ Project________ Grant________ % of fund______ Min._____/Hours_____Per Day
3. Fund______ Unit______ Account_______ Object______ Fiscal Yr.____ Project________ Grant________ % of fund______ Min._____/Hours_____Per Day
________________________________________________________________________________________________
______/______/______
Signature (Principal/Department Head)
Date
________________________________________________________________________________________________
______/______/______
Signature (Division Head) (Required if new unified/support staff position) (Attach Board Backup if available)
Date
PERSONNEL USE ONLY
Person Approved For Position: ________________________ Sex/Ethnic (Race): ____/____ S.S.#: __________________________________________________
Address: ____________________________________________________ City: _______________________ State: ________ Phone #: _____________________
(If new hire or returning employee)
(If Teacher, Major/Minor Fields: _____________________________________________ Certificate Held: __________________________________________ )
New Hire
Returning Employee
Current Employee
Promotion
Reassignment
Voluntary Transfer
Administrative - Voluntary
Administrative - Involuntary
FROM: (If CCSD Employee)
Position: _____________________________________________________________________________________ Grade Levels: _______________________
Location: ______________________________________________________________________ Months: ___________ Days: _______ Hours: ___________
TO:
Location: ______________________________________________________ Position Code(s) 1: ___________ 2: _________ Grade Level(s): ____________
(If Applicable)
Effective Date:______/______/______ School Year:______ - ______ Contract Status:
(If Licensed)
______/______/______
Salary: _____________ Salary Extra: _________________ Step: ______________ Class/Range: _________________ Job: __________________
Present CCSD Supervisor Notified/Approval Granted
New Supervisor Notified
Approved: __________________________________________________________________________
______/______/______
Personnel Administrator/Designee
Date
Distribution: Forward original and first copy for appropriate unit/division signatures
ORIGINAL: Appropriate personnel department
FIRST COPY: To be retained by unit supervisor
SECOND COPY: To be retained by originator
031/032
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