TAILIEUCHUNG - Appointment Activity Record

This form is to be used for teaching and research staff, executive officers, directors of various teaching, research, and library units, and curators. Please attach this form to a copy of the corresponding Job Requisition Printer Friendly and Goals web pages. After obtaining the appropriate approvals, submit it to Human Resource Records and Information Services along with the Instructional Hiring materials. After obtaining approvals, Flint and Dearborn units submit their materials to their regional HR office. Details of the selected candidate's appointment should be provided on the Appointment Request Form | The University of Michigan Appointment Activity Record Job Requisition Number This form is to be used for teaching and research staff, executive officers, directors of various teaching, research, and library units, and curators. Please attach this form to a copy of the corresponding Job Requisition Printer Friendly and Goals web pages. After obtaining the appropriate approvals, submit it to Human Resource Records and Information Services along with the Instructional Hiring materials. After obtaining approvals, Flint and Dearborn units submit their materials to their regional HR office. Details of the selected candidate's appointment should be provided on the Appointment Request Form (#36400). Please provide the following information for the selected candidate and any candidates that were seriously considered but not selected for the position. Please list the selected candidate first in the list. Name of Selected Candidate Ethnicity Gender Comments Name of Seriously Considered but Not Candidate (If any candidate differs from the selected one in ethnicity and/or gender, explain why he/she was not Selected Candidate Ethnicity Gender Outcome Comments selected. Attach additional pages if needed.) Summary of all candidates (including the selected candidate). Ethnicity Candidate # of American Outcome Gender # of Black # of Asian Indian # of Hispanic # of White # of Other Male Selected Female Unknown Male Seriously Considered Female Unknown Male Rejected Offer Female Unknown Male Not Interviewed Female Unknown Male Not Qualified Female Unknown Number on Search Committee (if applicable): Minority Non-Minority Male Female Scope of Search: Local State National Name of Chairperson of Search Committee (if applicable) Signature of Person Responsible for Placement Decision Date Signature of Unit HR Manager or Affirmative Action Coordinator Date Form 39906 Revised 07/01 To order this form, call (734) 764-9250 or visit Appointment .

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