CERTIFICATION ELIGIBILITY FORM
FORM - 3A.XLS
Class Title/ Position No.: _________________________________________
Department: ____________________________________________________
Interviewer:
Phone No.: ________________
Certified by: _________________________ Date: ____________________
Names are certified in alphabetical order.
All candidates must be interviewed. If a candidate cannot be contacted, the appointing authority is required to
document in the remarks section why the candidate could not be reached.
Detailed reasons
for non-selection of a candidate for the above referenced position must be placed in the remarks
section. Additional comments may be added on a blank sheet and attached.
After interviewing, fill in the name of the selected candidate (at the bottom of form), the expected date of
hire/appointment, and date the form. If no selection is made, please write "return for additional names" in the
selected candidate field. The certification eligibility form must be returned to Human Resources before the selected
candidate is placed on payroll.
Candidate Name Remarks
Selected Candidate Expected Date of Hire Date
Appointing Authority Date
CERTIFICATION ELIGIBILITY FORM
SUPPLEMENT
Use for additional names
FORM - 3A.XLS
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