ࡱ> M $bjbj== rWW9"ltttttttB"B"B"8z"l"C$F''''' +,BBBBBBB$D FBt-''--B&.tt''C&.&.&.-t't'B&.-B&. &.D8ttD8'$ )י{B"-jD8D8\ C0CD8G&.GD8&.tttt STATE OF IOWA EXECUTIVE BRANCH IOWA DEPARTMENT OF ADMINISTRATIVE SERVICES HUMAN RESOURCES ENTERPRISE BARGAINING EXEMPTION QUESTIONNAIRE This questionnaire is to be completed by the employee, or the supervisor when the position is vacant, whenever a position is proposed to be excluded from collective bargaining agreement coverage due to confidential or managerial responsibilities. If the position is proposed to be supervisory, the Supervisory Analysis Questionnaire (CFN 552-0193) should be completed. Attach additional sheets if answers to questions need further clarification. 1.Name: FORMTEXT       FORMTEXT       FORMTEXT      (Last)(First)(MI)18 Digit Position Number: FORMTEXT       2.Is this employee the personal secretary of any of the following:Check all that apply.Check here if none apply: FORMCHECKBOX   FORMCHECKBOX  An elected official of the executive branch.Name: FORMTEXT      Title: FORMTEXT        FORMCHECKBOX A person appointed to fill a vacancy in an elective office.Name: FORMTEXT      Title: FORMTEXT        FORMCHECKBOX The chair of a full-time board or commission.Name: FORMTEXT      Title: FORMTEXT        FORMCHECKBOX The director of a state agency.Name: FORMTEXT      Title: FORMTEXT        FORMCHECKBOX The division administrator of a state agency.Name: FORMTEXT      Title: FORMTEXT       3.Is the employee on the staff of the Auditor of State? FORMCHECKBOX  Yes FORMCHECKBOX  No 4.Is this employee on the staff of the Department of Justice? FORMCHECKBOX  Yes FORMCHECKBOX  No If yes, is this employee in the Consumer Advocate Division? FORMCHECKBOX  Yes FORMCHECKBOX  No 5.Does this employee have access to budgetary or other information developed for use in collective bargaining negotiations? FORMCHECKBOX  Yes FORMCHECKBOX  No If yes, explain the types and kinds of collective bargaining information to which the employee has access: FORMTEXT        6.Does this employee work in a close continuing relationship with anyone who is associated withcollective bargaining negotiations on behalf of the State?Yes FORMCHECKBOX No FORMCHECKBOX  If yes, provide the following information regarding the person who is associated with collective bargaining negotiations on behalf of the State:Name: FORMTEXT      Title: FORMTEXT       Describe the collective bargaining activities in which this person is engaged: FORMTEXT        7.Does the employee work closely with management representatives? FORMCHECKBOX  Yes FORMCHECKBOX  No If yes, identify the management representative(s) with whom the employee works, the management responsibilities of that person(s), and in what capacity the employee works closely with that management official(s): FORMTEXT        8.Does the employees relationship to management representatives create a conflict, or the potential for a conflict of interest, with coworkers? FORMCHECKBOX  Yes FORMCHECKBOX  No If yes, explain the conflict or potential conflict and how it affects the employees relationship with coworkers: FORMTEXT        9.Does the employee formulate or determine policies for the State or the department? FORMCHECKBOX Yes FORMCHECKBOX No If yes, explain the types of policies the employee formulates or determines and how those policies affect the employee s coworkers: FORMTEXT        10.Does the employee effectuate policies for the State or the department? FORMCHECKBOX Yes FORMCHECKBOX No If yes, explain how the employee effectuates policy and how this impacts the employee s coworkers: FORMTEXT        11.Does the employee have independent discretion to modify or in any way ignore the established operating procedures or policies of the State or the department? FORMCHECKBOX  Yes FORMCHECKBOX  No If yes, explain the limits of the employee s authority to modify or ignore established operating procedures or policies: FORMTEXT        12.Is there any additional information you wish to provide which may be relevant to determination of the collective bargaining status? 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