** Indicates required field Requester Information First Name of Requester** Last Name of Requester** Email Address of Requester** Phone Number of Requester** If requesting a specific person: Requested Employee's Name Requested Employee's Telephone # Requested Employee's Email Address If this is a Duke Hospital, Duke Raleigh Hospital, or Duke Regional Hospital position, do you have approval from the Labor Management Committee?** Yes No NA If yes, please include LMC approval grid: Department Information Department Name**** Formal name only -- no acronyms please Department Telephone #** Department Fax # Supervisor Information Supervisor's First Name** Supervisor's Last Name** Supervisor's Telephone #** Supervisor's Email Address** Position Information Projected Start Date for Order** Month January February March April May June July August September October November December / Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year 2019 2020 2021 Projected End Date for Order** Month January February March April May June July August September October November December / Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year 2019 2020 2021 **Duke Temporary Service employees may not be employed more than 900 hours during the fiscal year (July 1 - June 30). If you have questions, please contact your representative at 681-3132. Title of Position Requested Is there an open requisition for this position?** Yes No If yes, please include the requisition number** Job Code of Position Requested Shift Request** 1st 2nd 3rd Weekends Schedule Request** Full Time Part Time Summer Only Hours Requested: Start Time a.m. p.m. Hours Requested: End Time a.m. p.m. Health Screen Needed** Yes No Visual Screening Color Blind Near Vision Respirator Fit? Yes No DMV Check Needed? Yes No Will this employee be driving a Duke vehicle? Yes No If yes, what type of vehicle? Patient Contact?** Yes No High Containment/Special Pathogens?** Yes No Animal Handling?** Yes No Number of Employees Needed** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Reason for Request** Vacancy Vacation Military FMLA Other Is this request for project work? Yes No - If yes, please explain: Is this request for additional help? Yes No - If yes, please explain: Do you want to interview candidates? Yes No Do you want to review resumes? Yes No Does this position require the ability to initiate expense reports in the online expense report system?** Yes No Job Description**(include required certifications, licensures) **Please feel free to either type or cut and paste this section. Physical Location of Job Building Name** Street Address of Building** Suite/Room Number** Specific Directions to Job Location** Billing Information Company Code** Select a Company Code Company Code 10Company Code 14Company Code 20Company Code 21Company Code 24Company Code 26Company Code 28Company Code 30Company Code 40Company Code 41Company Code 50Company Code 51Company Code 60 ** Please enter either a Cost Center Number or a WBS (not both) Cost Center Number WBS Organizational Unit Number** SAP Organization Key**(DDxx - RCxx)**Must be a biweekly org key Timecard Approvers: Primary Approver's Name** Primary Approver's Duke Unique ID**(Duke Unique ID look-up) Backup Approver's Name** Backup Approver's Duke Unique ID**(Duke Unique ID look-up) Second Backup Approver's Name Second Backup Approver's Duke Unique ID(Duke Unique ID look-up) REMINDER: Duke Temporary Service (DTS) employees must be employed a minimum of thirty (30) calendar days before transferring into a regular position. DTS employees may not work more than 900 hours during the fiscal year (July 1 - June 30). If you have questions, please contact your DTS representative at 919-681-3132. REMINDER: Before you decide to convert an Aerotek or Grace Federal Solutions temporary employee to regular Duke employment, please remember a conversion fee will be charged to your hiring department based on his/her hours worked. The conversion fee is calculated using the annualized salary (2,080 hours) of the converted employee. Office Clerical and Light Industrial Positions: 0 - 240 hours worked: 18% of annualized salary 241 - 330 hours worked: 15% of annualized salary 331 - 480 hours worked: 10% of annualized salary After 481 hours: No fee Accounting, Professional, Technical (IT), Scientific, Clinical Research and Healthcare Positions: 0 - 480 hours worked: 18% of annualized salary 481 - 650 hours worked: 15% of annualized salary 651 - 960 hours worked: 10% of annualized salary After 961 hours: No fee If you have questions, please contact your Aerotek representative at 919-668-3823 or your Grace Federal Solutions representative at 919-668-3820.