Cellular Telephone Number. The University shall maintain a listing of employee separations in the union data library, which shall be updated monthly. This list will include: Name, University ID, Campus, Title, Hire date, Separation date, Unit/school, and Salary table. All information the University is required to provide will be provided in Microsoft Excel format.
Cellular Telephone Number. 13. Classification Description (FT or PT, per diem, exempt or non-exempt, bi- weekly standard hours)
Cellular Telephone Number. May I leave a voice message with appointment information? Yes No May I text appointment information? Yes No May I call you at this number? May I leave a voice message with treatment information? Yes No May I text treatment information? Yes No Yes No May I leave a voice message with billing information? Yes No May I text billing information? Yes No Additional Instructions:
Cellular Telephone Number. Fax Number E-mail Address Home address Postal address THUS DONE AND SIGNED BY THE PARENT AT ON THE DAY OF 20 . MOTHER FATHER SIGNATURE: For / on behalf of Xxxxx Pre- and Primary School NAME IN THE PRESENCE OF THE UNDERSIGNED WITNESS: 1. 2. Signature Signature Name Name
Cellular Telephone Number. If you provide us at any time with a wireless or cellular telephone number you agree that we contact you via that number for any purpose through any means available to us, including but not limited to, use of a pre-recorded or artificial telephonic message and/or an autodialer.
Cellular Telephone Number. 5. E-Mail Address:
Cellular Telephone Number. Include a brief description of the relevant information the witness may provide to support your complaint WITNESS #2 Name (first, middle, last) Address (number & street, city, state & ZIP code)
Cellular Telephone Number. Include a brief description of the relevant information the witness may provide to support your complaint Town of Xxxxxx Title VI Complaint Form OTHER FILINGS Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State court? 🞏 Yes 🞏 No If yes, check all that apply: 🞏 Federal Agency 🞏 Federal Court 🞏 State Court 🞏 State Agency 🞏 Local Agency Please provide information about a contact person at the agency/court where the complaint was filed Agency/Court Name Agency/Court Contact Name Agency/Court Address City State Zip Code Telephone Number Please sign and date below. You may attach written materials, photographs or other documentation that you think is relevant to your complaint. Printed Name Signature Date Please submit this form to: Xxxxxxx Xxxxx, Title VI Coordinator Town of Xxxxxx 000 Xxxxxxxx Xxxxxx Xxxxxx, IN 46304 Appendix F – Complaint Consent/Release Form COMPLAINANT CONSENT / RELEASE Name (first, middle, last) Telephone Number ( ) - Address (number and street, city, state, ZIP code) Case Numbers (if known) As a Complainant, I understand that during an investigation it may become necessary for the Town of Xxxxxx to reveal my identity to individuals outside of the Town of Xxxxxx Government in the course of verifying information or gathering facts and evidence to develop a basis for making a civil rights compliance determination. I understand that it may be necessary for the Town of Xxxxxx to share information, including personal details collected as part of its complaint investigation. In addition, I understand that as a complainant, I am protected by Title VI of the Civil Rights Act of 1964, as amended, and its related statutes and regulations prohibiting intimidation or retaliation for taking action or participating in an action to secure rights protected by the nondiscrimination statutes enforced by the Town of Xxxxxx.
