ࡱ>  CbjbjAA f.++C $/T~t^^^!######"#^^^^^#8^!^!V=@iC"!pt"} N0~TH#H#H#0^^^^^^^##F^^^~^^^^H#^^^^^^^^^ : UCLA Affirmative Action FORM A Interview and Hire Record For Career Staff Please use a separate sheet for each open position  Department Name: __ ____ ________ 4 Digit Department Code: __________ Year: _____________ Period Covering: November 1 to January 31 February 1 to April 30 May 1 to July 31 August 1 to October 31 Title Code/Position: _________/_____ _________________________________ Applicants NameDepartmentInterviewed ByTitle EthnicSexHire ActionReasons for Acceptance or Interview Code (1)CodeM/FYes (2)NoRejectionDate(Please Be Specific) Ethnic Code: Prepared by: _______________________________________ A Black/African American (Signature) B Asian/Pacific Islander _________ _ _______________ C American Indian/Alaskan Native (Type or Print) E Hispanic/Latino(a) Reviewed By: ________________________________________ F White (Department Management) Date: ________________________________________ 1/ Use Title Code only if applicant is a current UCLA employee 2/ See instructions on reverse side Phone: _______________________________________ This form should be retained in department for 3 years (FORM A) January 1995 Instructions for use of UCLA Affirmative Action Quarterly Report Form A INTERVIEW AND HIRE RECORD In order to comply with Federal regulations, and to monitor progress toward Affirmative Action goals, this form must be completed for each open position. This FORM A is to be retained in the originating department for a period of 3 years, and be available for possible audit. Title Code: Enter four digit code and classification name, e.g. (7243) Administrative Analyst, (4712) Administrative Assistant III. Etc. Date Recruiting Started: Date requisition is submitted to Campus Human Resources. Date Position Filled: Date applicant accepts position. Applicants Name: Include all individuals interviewed, including intradepartmental applicants. Department Interview Date: Enter initial interview date set with each interviewer. Interviewed By: Indicate interviewer(s) and, if different, the name of the individual making final decision. If a screening committee is used, please attach a list of members. Ethnic Identity: For definitions see Ethnic Identity Chart. Hire Action: If yes column is used, indicate new hire, lateral, demotion, or promotion. The movement 9transfer) of an employee for one job to another may be one of three types: Lateral transfer old job and new job title codes have same salary range maximum. Demotional Transfer New job title has a salary range maximum which is less than previous title code. Promotional Transfer New job title code has a salary range maximum which is higher than previous title code. Reasons can only be related to the minimum qualifications necessary to perform the job. Reasons for Acceptance Or rejection: Applicants race, color, religion, national origin, sex, or the need to meet Affirmative Action goals are not acceptable reasons. If additional space is required, attach an extra sheet. 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