Name of Immediate Supervisor
Title of Immediate Supervisor
Work Schedule: (Check all that apply)
Permanent Day Shift
Permanent Evening Shift
Permanent Night Shift
If applicable, how long has the current employee been performing the duties listed below?
1. MAIN PURPOSE OF THE JOB:
2. ASSIGNED DUTIES AND RESPONSIBILITIES - List duty and responsibility or task statements that
identify the essential job functions. Essential job functions are the fundamental job duties of a position
that if not performed will alter the job.
% OF TIME
% OF TIME
JOB DUTIES (continued)
Other Duties As Assigned:
3. LEVEL, FREQUENCY AND PURPOSE OF WORK CONTACTS: List the contacts and purpose of
each contact that this position has with individuals internal and external to the organization. Can
include staff, other companies, clients, customers, vendors and the general public. Contacts may be in
person, in writing or by telephone. May indicate how often the contact occurs.
Frequency: daily, weekly, and monthly contacts with several Divisions. The purpose of the
4. DECISIONS AND RECOMMENDATION RESPONSIBILITY: Inherent decision making and
5. EQUIPMENT USED - List equipment, machinery and tools used to complete this job, e.g., personal
computer, hand tools, measuring devices and lab equipment.
6. NATURE OF SUPERVISION RECEIVED - Check the type of supervision that is given to this
position. See Instructions Part II, Item 6 for definition of terms.
7. WORKING CONDITIONS: (Check all that apply)
Work involves exposure to uncomfortable or unpleasant surroundings. (Explain)
Work involves exposure to hazardous conditions which may result in injury. (Explain)
Work involves special physical demands such as lifting 50 pounds or more, climbing
ladders, etc. (Explain)
Work requires use of protective equipment such as goggles, gloves, mask, etc. (Explain)
PART III. RESPONSIBILITY FOR THE WORK OF OTHERS
This section should be completed if this position is responsible for the work of others.
NATURE AND LEVEL OF RESPONSIBILITY FOR WORK OF OTHERS:
A supervisor assigns and reviews the work of others, trains employees, recommends the selection,
promotion and termination of employees, approves Paid Time Off (PTO), approves time reports, conducts
annual performance evaluations, determines and resolves procedural problems, serves as spokesperson for
subordinates, explains policies and directives from management and issues formal disciplinary reminders,
warnings and reprimands.
A Lead assigns and reviews the work of others, instructs and motivates employees, is available for
immediate assistance or review and performs the work of subordinate positions.
a) Does this position supervise employees?
b) Does this position lead employees?
If yes, to a or b, list the names and classifications of the employees that this position supervises or
c) Check the ways that this position supervises or leads these employees.
Assign and review work
Approve leave, sign time cards
Sign annual performance ratings
Interview & select new employees
Discipline employees (counsel, recommend suspension & termination)
d) Supervisory responsibility of other employees who have supervisory responsibility. List the position
title and department. Showing an organization chart is recommended.
List the required levels of education, training, and experience that are required to perform the duties and
responsibilities of the position. This can include degrees, certifications, internships, and content
experiences directly related to the position.
Required (Desired) Training and Certifications
Level and Time of Required Experience
PART V. PERFORMANCE SYSTEM
PERFORMANCE STANDARDS - For each job function identified in Part II, list the standard(s)
necessary for satisfactory performance. Also describe the rating method.
Standard for Job Duty 1:
Standard for Job Duty 2:
Standard for Job Duty 3:
Standard for Job Duty 4:
Standard for Job Duty 5:
The following signatures indicate acknowledgment by the employee of the information on this form, when
applicable, and approval by the supervisor and Human Resources.
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