Fillable Phs-6051-1 FORM 6051-1

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Phs-6051-1 FORM 6051-1

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PARKLAWN SERVICING PERSONNEL OFFICE
AGENCY FOR HEALTH CARE POLICY AND RESEARCH
Merit Promotion Program
CERTIFICATE OF ELIGIBLES
ISSUED BY VACANCY ANNOUNCEMENT NUMBER
ISSUED TO VACANCY PROMOTION POTENTIAL
DATE CERTIFICATE ISSUED
This certificate will be void 60 days after date of issue unless an
extension of time is requested and approved.
The candidates whose names are listed below are referred for your consideration under the merit promotion program.
Please consider carefully the qualifications of each candidate.
NAME ORGANIZATION LOCATION REMARKS ACTION*
SIGNATURE OF EEO OFFICER TITLE
DATE
SIGNATURE OF SELECTING OFFICER TITLE
DATE
INFORMATION CONTACT FOR THIS CERTIFICATE
NAME TITLE PHONE NO.
* Use the following symbols in the Action Column: S = Selected; NS = Not Selected; D = Declined.
PHS-6051-1 (Rev. 05/90)
PSC Publishing Services (301) 443-6740
EF
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Phs-6051-1 FORM 6051-1

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Completed 27 February 2020

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