Yes No
Hispanics: Women: Asians: Disabled*
Yes No
invited, interviewed, selected
invited, interviewed, selected
invited, interviewed, selected
invited, interviewed, selected
invited, interviewed, selected
invited, interviewed, selected
invited, interviewed, selected
invited, interviewed, selected
Yes No
Date
Date
EEO/AA Officer
DHR-19 (Rev. 11-09)
I approve of this hire
Chief Executive Officer
No appointment will be processed without this form. [DHR Rules and Regulations Section 2520.770(h)]
8. Name and position of person(s) who recommended the selection of the candidate.
Section 2 (To be signed by agency EEO/AA Officer and Chief Executive Officer or their designees)
I have reviewed the eligibility list and concur / do not concur with this hire. Remarks on reverse side.
2. Was the position posted?
7. Name and position of person(s) who interviewed candidates.
4. Indicate the sex and race of the person promoted.
5. Did it change the employee's EEO job category?
were Disabled,
were Undefined,
6. If the category is underutilized and a member of an affirmative action group applied and was not
promoted, give a detailed explanation.
were Asian,
were Native American,
were Veterans,
3. Number of individuals who applied or were on the list of promotable(s)
were African American,
were Hispanic,
were Women,
African
Americans:
Native
Americans:
EEO Job Category:
1. Is the EEO category underutilized?
Number to be filled: Position Number:
If yes, by which of the following:
Date of Promotion:
Candidate's Name:
Pay Grade:
*For EEO monitoring purposes.
Facility / Unit:
Title of Job to be filed:
PROMOTION MONITOR
Section 1 (To be completed by designated agency personnel)
Name of Agency: IDHR Region:
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