Exempt Position Request	Instructions: Complete and send through the agency (if appropriate) to the Appointments Unit of the Governor’s Office who will forward it to CalHR. An advance copy should be sent to CalHR.
I.a. Appointee Information
Proposed Appointee	Effective Date	Salary	Salary Range	Level
If the appointee is currently a state employee:
Class Code	Current Salary Rate	Current Employing Department
I.b. Exempt Pay Scale Information
Current Information and Proposed Changes, if any: (Current information is available on Controller’s CSP Screen or the CalHR Website)
Schem Code	Class Code	Title
Current:
Proposed:
Salary Range	Exempt Level	Authority/Entitlement	WWG	MCR	CBID	Footnotes
Current:
Proposed:
New exempt class based on new legislation (attach a copy of the legislation). New exempt class based on the conversion of a civil service managerial position under Gov. Code 12010.6.
If new conversion, Civil Service Class to be Converted	Position Number
Definitions of Commonly Used Appointing Authorities
C - Constitutional Officer or Appointee (Not Gov. or Lt. Gov.)	F - Governor’s (or Lt. Gov.’s) Appointee
D - Board or Commission Member	G - Appointee of a Governor’s Appointee
E - Appointee of a Board or Commission
Modified Classification Review (MCR): NONE Review required when refilled. I No review required.	CBID: E97 Confidential E98 Supervisory	E99 Managerial E79 Managerial Specialist (Non-supervisory)
I.c. Requesting Department
Requester’s Title	Department
Requester’s Signature	Telephone Number	Date
II. Agency Approval
Name and Title of Approving Official	Agency Name
Signature of Approving Official	Telephone Number	Date
III. Governor’s Office Approval (Send to Appointments Unit, Attn. Lisa McVay)	(For CalHR Use Only)
Comments:
Name and Title of Approving Official	Telephone Number
Lisa McVay, Appointments Administrator	(916) 445-4541
Signature of Approving Official	Date

EPR.dot (01/19/2019)