Arizona Department of Administration
TRAINING PAYMENT AGREEMENT
APPLICANT/TRAINING INFORMATION
NAME
DIVISION
AGREEMENT
I UNDERSTAND AND ACCEPT THE CONDITIONS SET FORTH IN THE TRAINING PAYMENT POLICY AND AGREEMENT PERTAINING TO MY
PARTICIPATION IN THE TRAINING COURSE LISTED ABOVE. I UNDERSTAND THAT PAYMENT IS CONTINGENT UPON DIVISION FUNDING
AVAILABILITY. IF I LEAVE ADOA PRIOR TO TWELVE MONTHS AFTER COMPLETING THIS TRAINING COURSE, I AUTHORIZE ADOA TO
WITHHOLD FUNDS FROM MY PAYCHECK TO REIMBURSE THE DEPARTMENT FOR EXPENSES AS OUTLINED IN THE TRAINING PAYMENT
POLICY. I FURTHER UNDERSTAND THAT IF I FAIL TO REPAY THE AMOUNT OWED, ADOA MAY BRING CIVIL SUIT TO RECOVER THE BALANCE
AND I WILL BE RESPONSIBLE TO PAY ALL COSTS OF THAT ACTION, AS WELL AS REASONABLE ATTORNEY'S FEES INCURRED BY THE STATE,
IF THE STATE PREVAILS.
Signature
Date
APPROVAL - SUPERVISOR
APPROVE
DENY
Supervisor Signature
Date
APPROVAL - ASSISTANT DIRECTOR
APPROVE
DENY
COMMENTS
Assistant Director Signature
Date
WORK PHONE
TRAINING COURSE TITLE
ADDRESS
TITLE
SECTION
WORK E-MAIL
TRAINING INSTITUTION
CITY
STATE ZIP
DATE COURSE BEGINS DATE COURSE ENDS TUITION/REGISTRATION FEE
08/22/19
ADOA/HRD - FA5.02
COMMENTS
EXPLAIN HOW THIS TRAINING WILL HELP IN YOUR CURRENT POSITION OR IN THE NEXT STEP IN YOUR CAREER PATH WITHIN YOUR STATE
OF ARIZONA EMPLOYMENT. (ATTACH TRAINING DESCRIPTION AND FEE SCHEDULE)
Select Division From List
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