APPLICATION FOR EXTENSION BEYOND RETIREMENT by 03qZ8Xyu

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									 APPLICATION FOR EXTENSION BEYOND RETIREMENT
                SUPPORT STAFF
Please note that this form should be completed by all staff members even if
their posts will not be available for refilling as per their line manager.
Please discuss this with your line manager if you so wish before completion.

Candidates must complete Section A and submit signed forms to relevant
Head of School/Department who completes Section B and forwards to
Dean/Divisional Director.

If you do not wish to be considered for extension beyond retirement, please
complete the declaration form only, on page 7.


SECTION A: TO BE COMPLETED BY APPLICANT
1.        Personal Details

Name:                                                       Staff Number
Title of Post:
School/Department/Section:
Faculty/Division:
Peromnes Level:                                              Post Number
Date of Retirement:
Details of Previous
Extensions granted by
Retirement Committee:
Period of Extension being
requested?
(Please provide a brief
motivation for this request).




2.     Minimum Requirements
Please note that your application will only be considered if you meet the following
minimum requirements:

     1.   Sustained high level of performance as assessed by your line manager.
                                            and
     In addition you must meet one of the following minimum requirements:
     2. Possession of specialized or scarce skills and qualifications that are difficult to
         replace through normal recruitment due to prevailing market factors
     3. Key level of involvement in a major university project where continuity is
         imperative for success.




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Please provide a short motivation detailing how you meet the above minimum requirements:




3.      Additional Requirements

You must in addition to the above meet at least three of the following requirements.
Please tick if applicable and attach any supporting documents to this application form
including referee letters, certificates etc:


                                                                                          Tick()
1.   Contribution to capacity building within your specialized area of operation.




2.   Recognised standing in your profession or in professional or learned societies
     outside the University. Motivate




3.   Evidence of continuing professional development and adaptability to new trends
     and developments in your field of expertise. Motivate.




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4.   Evidence of leadership within your operational unit or the University. Motivate.




5.   Evidence of innovation and customer orientation in performing duties. Motivate




6.   Excellence in University service. Motivate.




I confirm that the statements made above are true and accurate.

Name of Candidate: _________________________________

Signature:     ________________________            Date: ___________________


Please submit this completed form to your Head of School/Department.


                                                                                        3
                                                             CONFIDENTIAL

APPLICATION FOR EXTENSION BEYOND RETIREMENT

SECTION B: TO BE COMPLETED BY HEAD OF SCHOOL/
DEPARTMENT

NAME OF APPLICANT:
STAFF NUMBER:

(The Head of School/Department is required to confirm the statements made by the
candidate above as well as comment on the candidate’s level of performance. Please
append additional pages if necessary)

1.     Performance Rating
Please consider performance over the past three years.

RATING               EXPLANATION/MOTIVATION                                Tick()
Above Expectations




Meets Expectations




Meets Most
Expectations




Unsatisfactory




ADDITIONAL COMMENTS




                                                                                4
NAME OF CANDIDATE:
STAFF NUMBER:


I confirm that I have read the application form and verified the statements made by
the above candidate. The post is available for refilling.
I support the application/do not support (Delete as applicable) the application
for the following reasons:




Name of Head of School/Department: ____________________________________

Period of Extension recommended: _______________________________

Signature: _________________________            Date: ______________________


Head of School/Department to forward completed form to relevant
Dean/Divisional Director.




                                                                                 5
CONFIDENTIAL

APPLICATION FOR EXTENSION BEYOND RETIREMENT

SECTION C: TO BE COMPLETED BY DEAN/DIVISIONAL DIRECTOR

NAME OF CANDIDATE:
STAFF NUMBER:

Application Supported/Not supported (Delete as applicable)


Reasons:




Name of Dean/Divisional Director: ______________________________________

Signature: _____________________________        Date: ______________________


Dean/Divisional Director to submit completed forms to the relevant
Executive member to convene the College /Support Sector Retirement
Panel.




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                                             DECLARATION



I.............................................., staff number.............., hereby declare that I do
not wish to be considered for extension beyond the normal date of retirement. I
confirm that I will retire on..../.../20...... (dd/mm/year).


Signed at ................................on this..... day of....... 20


.............................................................      ……………………………………………………….
(Full Name of Retiree)                                                              (Signature)


I ......................................................................................................... confirm
that I have been advised that the abovenamed does not wish to be considered for
extension beyond retirement and the necessary succession plans will be
implemented to mitigate any risk to the University in terms of achieving its
operational objectives.




Signed at..............................on this..........day of................................20




...........................................................        …………………………………………………….
(Full Name of Head of School/Department)                                         (Signature)




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