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Staffing Requisition

Staffing Requisition/Recruitment Request Form

Date of Request(Required)

MM slash DD slash YYYY

Number of Positions to Fill:(Required)

Hiring Manager:(Required)

Department:(Required)

Position Information

Position Title:

Replacement for (include name & effective date):

New Positions: (Send job duties and qualifications to kchchr@kinstonchc.org )
Job Description must be completed before date of hire

Position Status: (Check one)

Full Time

Part Time

Position Status: (Check all that apply)

Seasonal

Permanent

Temporary

Bilingual

PRN

Grant Funded:

Yes

No

Grant Type:(Required)

Contact Finance for this information

Is this an internal transfer?

Yes

No

Employee Name:(Required)

Effective Date of New Position:(Required)

MM slash DD slash YYYY

Current Position:(Required)

New Position:(Required)

Current Supervisor:(Required)

New Supervisor:(Required)

Current Grant Type:(Required)

New Grant Type:(Required)

Contact Finance for this information

Kinston Community Health Center, Inc

(252) 522-9800

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Addresses

Physical Address
324 N. Queen Street
Kinston, NC 28501
Mailing Address
P.O. Box 2278
Kinston, NC 28502
Kinston Community Behavioral Health Center
107 S. Queen St.
Kinston, NC 28501

This health center receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims
including medical malpractice claims, for itself and its covered individuals.
2024 Kinston Community Health Center, Inc