Employee: ________________________ Department: ________________________
Job Title: _____________________________ Grade: _______
1. Employee's request (suggested classification):
2. Employee's statement of Appeal (attach a copy of a revised position analysis questionnaire or other documents for justification).
Signature of Employee/Date:______________________________________________
Immediate Supervisor's Signature/Date: _________________________
Agree ___ Disagree ___
Division Supervisor's Signature/Date: _________________________