LOI checklist attachment-Attach this checklist to all draft by HC120808003416


									CLO/New Appointment checklist-Candidate’s Name _______________________________________________
A. Search
This candidate is proposed to fill the position identified in the Dept’s FY _______ Budget ____________________________ Position ID

Is a national search required for this position? Yes         or No         If yes, provide a copy of the ad(s), applicant log and search memo
B. Candidate         CV and Bibliography          Vertebrate form       Citizenship form       MSO Application for Appt/Release of Info forms (Pgs 3,4,19,20,21) ( optional)

C. Package
Will the candidate be provided research start up funds? Yes or No                  If yes attach additional spending plan.
Does this recruit engage in cancer-related research? ? Yes or No                  If yes, has this recruitment and possible research support from the UCCRC been
discussed with the Director of the UCCRC? Yes or No

Equipment $___________________ over _______yrs.
Call the Director of Operations/Planning if this recruitment requires: purchase of large or unusual equipment or equipment with intensive electrical requirements.

Technician $ _________ FTEs ___ over ____ yrs. Other personnel $ _________ FTES ___ over ____ yrs. Research supplies $ _________ over ____yrs.

Number of Graduate Students accompanying recruit to the UOC. __________

Will the candidate require biostatistics or epidemiology research support? Yes or No
If yes, would it be sought from the Biostatistical Consulting Laboratory (BCL) in the Dept. of Health Studies? Yes or No
If yes, has the BCL Director or Chair of Health Studies been contacted? Yes or No If yes, attach copy of e-mail confirming arrangements.
If no, how will the candidate’s needs be met? (specify resource)____________________________________________________________

Does the candidate have significant Information Service requirements? Yes or No If yes attach explanation or e-mail from IS confirming
Examples of significant IS requirements: Acquiring, developing, and installing a major computer system or research database; developing a network within
the patient care community or among collaborative universities; file/data storage of greater than 250 gigabytes, etc.
Have you contacted BSD IS regarding how this IS requirement can be supported? Yes           or No If yes attach explanation or e-mail from IS confirming
Will the candidate require the use of Divisional Core Facilities? Yes or No Has OSRF been contacted to determine if appropriate resources are currently
available? Yes or No Are there any unusual financial arrangements to support this use (other than grant support for usage fees)?
Yes or No If yes to any questions, either attach an explanation or e-mail from OSRF confirming arrangements.

Will facilities be provided? Yes or No Are the proposed facilities included in the current Department inventory? Yes                         or No
Renovation proposed Yes or No
Has the Department budgeted the cost of this project? Yes or No If yes provide account # _____________________
If no, is it expected that the Division will fund this project? Yes or No
If yes, attach a copy of the Capitol Project Checklist. Yes or No

Teaching [For all “Basic Science” depts., Health Studies, and Human Genetics depts. only] has the “Teaching” section of the CLO been mailed to the BSCD
Master j-quintans@uchicago.edu Yes or No

Office location-building/room number(s) _____________ Estimated renovation and furnishing costs _______________Source of funding____________________
Is this in your current FY budget (if funding is a ledger 2 acct.): Yes or No if yes where___________________________________________________________

Research lab location-building/room number(s)____________ Estimated renovation and furnishing costs _______________Source of funding_______________
Is this in your current FY budget (if funding is a ledger 2 acct.): Yes or No if yes where____________________________________________________________

Provide the following information if there are revenues associated with this recruitment:
Direct Restricted Costs (first yr.) _____________ Salary recovery/source (first yr.) ______________ Total IDC’s (first yr.) ________________
Give the details of grants, contracts, and other funds/equipment the candidate may bring (attach explanation):

D. Clinical Recruits-recommend attaching business plan
Permanent Illinois license required? Yes or No
Malpractice coverage needed from our self-insured indemnification program Yes or No
Anticipated net revenues (collection rate multiplied by charges) from clinical activity and external income (both annualized first year)$__________________
Are hospital facilities/financial resource commitments involved? Yes or No If yes attach written commitment from the UCH, i.e., the CEO, COO or CFO only.

E. Space/Financial Resources
E-mail OR sign/date from Budget______________________ E-mail OR sign/date from Director Operations/Planning______________________

_________________________                    ____________________
Signature of Chairman                        Date                 Comments-attach additional sheet                                     06/04 LB

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