REENTERING RETIREES APPROVAL REQUEST

1

Name:* This field is required.Provide the name of the Agency/Department Officer completing and/or submitting this form.

First Name

Last Name

2

Email Address:* This field is required.Provide the email address for the Agency/Department Officer completing?submitting this form. A copy of this request will be sent to this email address for your records.

example@example.com

3

Select your Agency/Department:* This field is required.

4

Is the vacancy to be filled a Nurse, Teacher*, or Police Officer?* This field is required.*For the purposes of this form, "Teacher" does NOT include Substitute Teachers.

YESNO

5

Is the vacancy to be filled a Substitute Teacher?

YESNO

6

Vacancy to be filled:* This field is required.

7

Upload your approved PRF* This field is required.

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Select files to upload

Max. file size: 10.6MB

8

Job requisition number: * This field is required.

9

Has vacancy been available on NEOGOV for at least 3 consecutive months?* This field is required.

YESNO

10

Have any qualified internal/external candidates been identified to fill this vacancy?* This field is required.

YESNO

11

Retiree's effective date of retirement from Government service:* This field is required.

Date

12

Upload copy of retiree's retirement NOPA* This field is required.

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Max. file size: 10.6MB

13

Retiree's name* This field is required.

First Name

Last Name

14

Retiree's Employee Number* This field is required.

15

Indicate your recruitment efforts to fill this vacancy:* This field is required.Select ALL efforts utilized to fill this vacancy.

Internal advertising via NEOGOV

External advertising via NEOGOV

Job/Career fair

Recruitment drive

Social media marketing campaign

News media marketing campaign

Other

16

Other recruitment efforts:You indicated that you engaged in "Other" recruitment efforts. Explain in detail the efforts you engaged in to fill this vacancy. Include details such as dates, frequency, location, etc.

0/0

17

Describe your recruitment efforts:Please provide details regarding the recruitment efforts engaged to fill the vacancy outside of NEOGOV. Include details such as dates, frequency, location, and platform utilized for each recruitment effort selected.

0/0

18

Detailed recruitment/succession plan:* This field is required.Be sure to include detailed recruitment efforts that will be used, in anticipation of the end of the retiree's term, to fill the vacancy on a permanent basis, including the development of a succession plan.

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Max. file size: 10.6MB

19

ATTESTATION* This field is required.I attest to the following: • That I am an officer with the authority to make this request to rehire a retiree; • That there is no other qualified candidate identified to fill this vacancy; • That if approved, the retiree's reemployment under this program shall be on a temporary basis only; • That it is my responsibility to read any applicable statutes, regulations, and policies governing this request to rehire a retiree; • That all the information I have provided in this application is true, complete, and accurate to the best of my knowledge and belief; and • That I understand that any omission, inaccuracy, or failure to make full disclosure are grounds for the Hiring Agency Head to deny approval of my request and may subject me to disciplinary action.

Yes, I attest to the statements above.

20

Sign this application using the following format: "/s/ first name & last name"Typing your name below is the equivalent of signing this document.

21

Please verify that you are human* This field is required.