CERTIFICATION AND SIGNATURE. This is to certify that the person named above meets all the eligibility criteria for the Household Member. I understand that I will be responsible for paying any costs for enrollment in the plan and any taxes associated with enrolling a Household Member.* I also understand that any information falsified on this document may result in discipline up to and including termination from employment.
Appears in 19 contracts
Samples: Collective Bargaining Agreement, Faculty Agreement, Faculty Agreement
CERTIFICATION AND SIGNATURE. This is to certify that the person named above meets all the eligibility criteria for the Household Member. I understand that I will be responsible for paying any costs for enrollment in the plan and any taxes associated with enrolling a Household Member.* I also understand that any information falsified on this document may result in discipline up to and including termination from employment.
Appears in 4 contracts
Samples: Collective Bargaining Agreement, Collective Bargaining Agreement, Collective Bargaining Agreement
