Fillable REQUEST FORM TO INCLUDE MATERIAL IN PROFESSIONAL FILE

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REQUEST FORM TO INCLUDE MATERIAL IN PROFESSIONAL FILE

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The REQUEST FORM TO INCLUDE MATERIAL IN PROFESSIONAL FILE form is 1 page long and contains:

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Country of origin: US
File type: PDF

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T
O:
FROM: ____________________________________________________
REQUEST FORM TO INCLUDE MATERIAL IN PROFESSIONAL FILE
Thomas G. Coley, Ph.D., Acting President
_
Print Full Name and position
The items listed below are attached and submitted for inclusion in the Professional File of the following staff
member concerned: __ ________________________________
Prior to submitting the original documents, please make copies for yourself.
1. _ ________________________________________________________________________________
2. _ ________________________________________________________________________________
3. _ ________________________________________________________________________________
SIGNATURE: _______________________________________ DATE: _____________________
_________________________________________________________
TO:
FROM:
Director of Human Resources
Thomas G. Coley, Ph.D., Acting President
Request to include above-listed material in Professional File is approved.
Request to include above-listed material in Professional File is denied
SIGNATURE: _______________________________________ DATE: _____________________
_________________________________________________________
THE FOLLOWING WILL BE SENT IF APPLICABLE
TO: _____________________________________________________
(Staff member concerned)
FROM: Director of Human Resources
The following material may not be included in your Professional File for reasons noted:
_____________________________________________________________________________________________
_______
______________________________________________________________________________________
_______
______________________________________________________________________________________
SIGNATURE: ________________________________________ DATE: _____________________
Distribution of Completed Form:
Staff Member Concerned, Email Confirmation of documents added to file
Professional File, original document with attachment(s)
Revised 1/2018
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REQUEST FORM TO INCLUDE MATERIAL IN PROFESSIONAL FILE

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Completed 2 September 2020

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