BILINGUAL CERTIFICATION REQUEST
FOR TESTING AND PAY
EMPLOYEE NAME: DATE:
DEPARTMENT:
How frequently and in what capacity is this employee’s contact with citizens and others speaking this language?
How does this employee’s language skills assist the department in the performance of duties and/or department’s
delivery of service?
Will the employee be reasonably available to assist other departments with Bilingual language related needs?
___Yes ___No
Department Director Signature Date
Director of HumanResources Signature Date
TO BE COMPLETED BY HUMAN RESOURCES:
Date Test Scheduled: Did Employee Pass?
___Yes ___No
APPENDIX E
FORM 30
Page 243 of 254
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signature
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