Request to Post Faculty Position
Department of Pediatrics


General Information

 *Anticipated Rank: 
         Position Title:  
 
*Division: 
        FTE:   Yes  No


 *New position: 
  Replacement:     Who is this position replacing?  

*Was the position budgeted and approved by Children's Physician Group (CPG) or by the Pediatric Research Centers?  Yes  No

If yes, which entity approved?  

Justification for position. Please explain why this position is necessary and how it will contribute to the Department's mission and strategic plan.
 


Impact to organization, if position is not filled:
 


*Anticipated Funding Sources and percentage:
  Smartkey







Name  







Percentage(%)  








*Please list members of Search Committee along with Race/Gender information.

Should be a minimum of three (3) people. If appointment is for an Associate Professor or Professor rank, SOM prefers to have at least one person from outside of the DOP on the Search Committee. List only those who are primarily responsible for determining if an offer will be made.

  Name






Race  






Gender  






 
List journals, electronic bulletin boards, on-line postings, etc where position will be posted. Please contact Pam Coltrane if you would like assistance with posting in these external sources.

Copies of those ads should be sent to Pam Coltrane, and the posting requisition number and other required Emory verbiage must appear in the ad.







Please attach copy of job ad you would like posted on Emory website. Please submit electronic copy to Pam Coltrane.

Health and Safety Questions
       

Does this position involve supervising other employees? 
 Yes  No 

Will this position work for Emory Healthcare, the Schools of Medicine, Public Health, or Nursing, Yerkes, or the Psychological, Counseling or Student Health Centers AND do research that involves studying people or using information that identifies them? 
 Yes  No 

Does this position involve animal contact - Division of Animal Resources (DAR) or laboratory work with lab animals? 
 Yes  No 

Does this position work in a laboratory? 
 Yes  No 

Does this position involve work in a biosafety level 3 laboratory? 
 Yes  No 

Does this position involve clinical patient contact? 
 Yes  No 

Does this position involve radioactive materials and/or radiation devices? 
 Yes  No 

Does this position involve working with human blood, body fluids, tissues, cells, or other potentially infectious materials? 
 Yes  No 

Does this position involve working with nonhuman primates (nhp), nhp tissue, body fluids or equipment contaminated by nph? 
 Yes  No 

Does this position involve work with animals deliberately given infectious agents and/or involve work above animal biosafety level 1? 
 Yes  No 

Does this position involve working with patient information? 
 Yes  No 

Does this position involve shipping infectious agents or biological materials? 
 Yes  No 

Does this position involve working with a Class 3B or 4 laser? 
 Yes  No 

Will this employee be performing work where respiratory protection will be required? 
 Yes  No 

Does this position involve potential exposure to hazardous chemicals but work outside the laboratory? 
 Yes  No 

Will this employee need unescorted access to an irradiator? 
 Yes  No 


*Person completing form:

*Email


By submitting this document, I attest that this position has been discussed with and approved by the Division/Center Director