rev 10/14
REQUEST FOR RIF REPORT REVIEW
PART 1 TO BE COMPLETED BY EMPLOYEE
NAME: L Number:
I request that the following items be reviewed:
RIF Unit Placement (list correct RIF unit and explain why)
Seniority (describe errors in your seniority total)
Certification (Check ADD or DELETE box for each change listed):
ADD
DELETE
Course/Activity Title
Course Number
Employee Signature: __________________________________________ Date: ___________
Please attach additional page(s) for explanations.
PART 2 TO BE COMPLETED BY DIVISION DEAN (if needed)
A) I have reviewed the certification changes requested above and Agree Disagree.
If you agree with employee’s request to add/delete course certifications, you MUST complete a Faculty
Certification Form and the employee and you must sign the Faculty Certification Form.
The Faculty Certification Form is attached.
If you disagree with employee’s request to add/delete course certifications, a written explanation must be
included
A written explanation of disagreement is attached
B) I have reviewed to recommendation for change in RIF unit and Agree Disagree
A written explanation of agreement or disagreement is attached
Division Dean Signature_____________________________________ Date _______________
Please use additional page(s) for explanations.
PART 3 TO BE COMPLETED BY EXECUTIVE DEAN (if needed)
I have reviewed the recommendation for change in RIF unit and Agree Disagree
Executive Dean Signature_______________________________________ Date________________
Please use additional page(s) for explanations.
PART 4 TO BE COMPLETED BY HUMAN RESOURCES
Seniority Revision: Approved Denied By: ___________________________ Date_______
Explanation for denial is attached
Corrected Seniority_______________ Entered by_______________ Date_______
Corrected RIF unit________________ Entered by_______________ Date________
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