Name:

Division:

Title:

Bureau:

Salary Grade:

Unit:

Work Address:

Number of Years in Present Position:

Field Employee: (Yes or No)

Describe Your Job:

List the major activites you are responsible for and the average amount of time you spend on each activity:

% of Time: Activity:

Tasks:

% of Time: Activity:

Tasks:

% of Time: Activity:

Tasks:

% of Time: Activity:

Tasks:

Identify the knowledge, skills and abilities required for you to perform your job effectively:

Do you supervise staff? (Yes or No)

If yes, please identify below how many staff you supervise, the nature of the supervision and the title and grade level of each person:

Are you aware of other NYS Government positions responsible for the same/similar type of work that are compensated at higher levels? (Yes or No) If Yes, then please list below

Does your current title series provide you with adequate advancement opportunity? (Yes or No) If no, why do you believe this to be so: