REQUEST FOR MANAGERIAL/CONFIDENTIAL DESIGNATION 
AGENCY 
FACILITY/LOCATION/ 
ORGANIZATIONAL UNIT 
JOB 
TITLE 
ITEM NO. 
INCUMBENT 
NAME 
WORK 
ADDRESS 
WORK PHONE# 
SUMMARY OF DUTIES: (Be specific; attach copy of current job description) 
NARRATIVE JUSTIFICATION FOR M/C DESIGNATION: If seeking a confidential designation, fully develop 
correlation between incumbent's duties and the relevant M/C criterion. For all positions, reference must be 
made to changes in job content that occurred since the current designation of the position. Failure to 
elaborate here may result in the immediate rejection of your request. 
5/98 
AGY/FAC CODE 
SALARY 
GRADE 
NEGOTIATING 
UNIT NO. 
JURISDICTIONAL 
CLASS 
STATUS OF 
INCUMBENT