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The information above is accurate and completed by Signature Date Name Print Title OSER-DAA-11 Rev. 9/2011 Ch. 230 Stats. State of Wisconsin Office of State Employment Relations Division of Affirmative Action Form OSER DAA-11 Written Hiring Reason for Classified and Project Appointment Complete this form for each new hire and promotion in permanent classifications and project positions. Agency Secondary Unit Div* Bureau etc* Position Classification Certification Number Name of Person Appointed Date of Appointment Appointment Type Appointment For Permanent Classification Position or New Hire or Promotion Project Position 1. Hiring Decision Check ALL that applies. A. B. C. D. E* A veteran or a spouse of a veteran as defined in s. 230. 03 14 was hired* Service in designated wartime period is required A person with a disability was hired* The position is in a job group that is underutilized for racial/ethnic minorities and a racial/ethnic minority was hired* None of the above. If A B C or D is checked skip the rest and sign the form* If E is checked complete Sections 2 3 and 4. 3. Statistical Summary Check ONE box below which describes the most significant reason given in Section 2 for selecting the person who was appointed* The selected person served in this position or a similar position previously. 4. Additional Information Check all that applies. There were no veterans on the certification list. There were no self-identified persons with disabilities on the list. Persons from A B C or D above were on the list but all either declined an offer failed to report were not available were not located or were not interested in or eligible for the position*. Agency Secondary Unit Div* Bureau etc* Position Classification Certification Number Name of Person Appointed Date of Appointment Appointment Type Appointment For Permanent Classification Position or New Hire or Promotion Project Position 1. Hiring Decision Check ALL that applies. A. B. C. D. E* A veteran or a spouse of a veteran as defined in s. Hiring Decision Check ALL that applies. A. B. C. D. E* A veteran or a spouse of a veteran as defined in s. 230. 03 14 was hired* Service in designated wartime period is required A person with a disability was hired* The position is in a job group that is underutilized for racial/ethnic minorities and a racial/ethnic minority was hired* None of the above. 230. 03 14 was hired* Service in designated wartime period is required A person with a disability was hired* The position is in a job group that is underutilized for racial/ethnic minorities and a racial/ethnic minority was hired* None of the above. If A B C or D is checked skip the rest and sign the form* If E is checked complete Sections 2 3 and 4. If A B C or D is checked skip the rest and sign the form* If E is checked complete Sections 2 3 and 4. 3. Statistical Summary Check ONE box below which describes the most significant reason given in Section 2 for selecting the person who was appointed* The selected person served in this position or a similar position previously.

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