Human Resources

Los Angeles Unified School District

REQUEST FOR SCHOOL BASED ADMINISTRATOR ASSIGNMENT

TO: Maria Voigt, Coordinator Human Resources Beaudry Site-15th Floor Tel. (213) 241-6365; Fax (213) 241-8403 Local District Superintendent Name To: From: Select One Position Title Position Title Reason for vacancy: Other: Select One Selection Process: Other: Select One Select One Local District Employee Number Location Location Date:

From:

Fund

Appropriation # Position I.D.

Replacing: Effective Date:

Type of Assignment: Transfer Eligible List Appointment AR 4213 Appointment

AR 4214 Approved:

(AR 4213 appointments when fewer than 5 eligible list candidates, and/or current incumbents who have served at their current location for at least three years, apply for the position.) Appointment (AR 4214 appointments must submit appropriate form with rationale) Date : Maria Voigt, Coordinator, Human Resources

LAUSD/HR Form 9161-D 8/2011

Disapproved:

LAUSD/HR Form 9161-D 8/2011