DATA SHEET FOR FACULTY MEMBERS
Name of the Employee
Date of Employment
Division
Faculty Rank
Full-Time / Part-Time
Educational Credentials
List Below All Postsecondary Education; Beginning With the Most Recent
Name of the Institution
Major
Degree
Date
Received
List Below Any Certificate (S) / License (S) Held
Name of the Certificate/License
Employment Information
I CERTIFY THAT THE ABOVE STATEMENTS ARE TRUE, TO THE BEST OF MY KNOWLEDGE
Signature of a Faculty Member:
Date
Name of Employer
Title
Nature of Duties
Dates Employed
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signature
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