Supervisor Signature. I certify the nominee meets the prerequisites, or, if not met, I will put the reasons for attending the course in Remarks. Click here to enter text. Remarks Click here to enter text. PMS 921-2(799) NFES-2131 Nom form Part II - Agreement to Collect Funds (Complete only if there is a tuition charge) Course: Click here to enter text. Nominee Name: Click here to enter text. Tuition: Click here to enter text. Please check the section appropriate to the legal authority to collect monies and complete the address/signature block. This form must be signed by an individual with authority to sign agreements and obligate the funds listed. Note: Tribal governments are not covered by the Intergovernmental Cooperation Act of 1968.
Supervisor Signature. By signing below I acknowledge that I have read and understand this contract AND I have discussed it with the graduate student named above. Supervisor Signature Supervisor Name (Please print) Date Scan and send completed and signed contract to xxxxxxxxxxxxxxxx@xxxxxxxx.xxx. You must also include a signed and completed SEHF with the contract. GRADUATE COLLEGE USE ONLY – DO NOT COMPLETE BELOW THIS LINE
Supervisor Signature. Signature of Volunteer Supervisor or Accepting Official verifies total amount of voluntary service time donated. x. XXXX SIGNED (YYYYMMDD). Date signed by Volunteer Supervisor or Accepting Official.
Supervisor Signature. (print name)............................................. (print name) .................................................. Date: / /2007 Date: / /2007
Supervisor Signature. (print name)............................................. (print name) .................................................. Date: / /2007 Date: / /2007 Approved (Director ANBG) ................................................. Date: / /2007 * All volunteers are required to sign in to keep record of when they are on site. Australian National Xxxxxxx Xxxxxxx XXX Xxx 0000 Xxxxxxxx XXX 0000 Tel: (00) 0000-0000 Fax: (00) 0000-0000 website: xxx.xxxx.xxx.xx/xxxx Guidelines for Parks Australia Volunteers at ANBG1 January 2007
Supervisor Signature. This is where the Superintendent or his/her designee in charge of crew would sign. Employee signatures at beginning of shift: This is where each employee signs before each task starts indicating that they have given their input into STA preparation and that they understand hazards associated with the performance of task and what type of PPE if any is required for guarding them against the hazards associated with task performance. General Safety, PPE Required, Fall Protection, Electrical Ladders/Scaffolds, Material Handling, Permits, Welding/Burning, and Steel Erection: Any items that would require a “yes” answer require discussion by the Superintendent or his/her designee with members of the crew performing task prior to task being performed. This is to insure that all members of the crew understand the task to be performed, the hazards involved, the proper personal protective equipment to be used, and that tools and equipment to be used are all in safe operable condition. List the tasks and hazards that are expected today: This space is provided to list out each task that the crew is to perform during the shift and provides a means to list out the hazards related to performance of assigned tasks. How will you eliminate or control hazards? Now that hazards have been identified by filling out the above section this space is to be used to prepare a plan of action for controlling hazards or eliminating them. POST SAFETY TASK REVIEW This portion of the Safety Task Assessment is provided for the Superintendent and his/her designee to review the events of the day as it relates to the tasks that have been performed. If there have been any near misses reported during the shift in relation to the task being performed then they need to be described here so that the “Near Miss Report” can be completed. Any problems encountered during completion of task are to be noted so that planning can be done better prior to the task being performed the next time. Special attention is to given to any safety related problems or unforeseen hazards. Was the work area cleaned at the end of the shift? This will reduce the possibility of hazard exposures being left for other employees who may be working in the area the next time. Any miscellaneous items should also be noted for future consideration. It is required that the Superintendent and his/her designee sign the report in the spaces provided to insure that each has been given an opportunity review the report. This also provides fo...
Supervisor Signature. Date: REBUTTAL Rebuttal: If an employee believes the evaluation contains factual errors, or the inadvertent exclusion of necessary information related to the employee’s evaluation, the employee may fill out a rebuttal form. Rebuttals must be precise, yet thoroughly explain what is believed to be factually incorrect or omitted in the evaluation. Supporting documentation should be included. An employee can request a follow-up meeting with their supervisor to present the rebuttal. Rebuttals should be completed by 09/01. Bargaining unit members may seek the assistance of the District Xxxxxxx or the Chief Xxxxxxx in writing the rebuttal. Rebuttal: Employee Signature: Date: Supervisor Signature: Date: APPENDIX D. ORAL PRESENTATION ESP UNION SUPPORT STATEMENT Oral Presentation ESP Union Support Statement I , confirm the statement made by (Print Grievant Name) (Print District Xxxxxxx Name) on my behalf regarding my grievance on is correct. I understand that my (Date) next opportunity to address this grievance is at step two of the grievance process.
Supervisor Signature. The supervisor will review the CD-14B and if approved will sign the Workers copy for the file. MEMORANDA HISTORY: CD05-72; CD07-
Supervisor Signature. Signature of Volunteer Supervisor or Accepting Official verifies total amount of voluntary service time donated. x. XXXX SIGNED (YYYYMMDD). Date signed by Volunteer Supervisor or Accepting Official. BASIC CRIMINAL HISTORY AND STATEMENT OF ADMISSION (Department of Defense Child Care Services Programs) OMB No. 0704-0516 OMB approval expires: 20241031 The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod- xxxxxxxxxxxxxxxxxxxxxx@xxxx.xxx. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PRIVACY ACT STATEMENT AUTHORITY: 34 U.S.C 20351, Child Care Worker Employee Background Checks Requirements for Background Checks; Public Law 115-91, Section 925, (NDAA for FY2018) Background and Security Investigations for Department of Defense Personnel (10 U.S.C. 1564 note); 5 U.S.C. 9101, Access to Criminal History Records for National Security and Other Purposes; Executive Order 10450 Security Requirements for Government Employees; DoD Instruction 1402.05, Background Checks on Individuals in DoD Child Care Services Programs; DoD Manual 1402.05, Background Checks on Individuals in Department of Defense Child Development and Youth Programs. PRINCIPAL PURPOSE(S): To collect criminal history information of DoD personnel or contractors seeking to work with children in DoD child care services programs. Information received may be used to assess preliminary interim, on-going, or final suitability/fitness of DoD personnel or contractors working with children in these programs. ROUTINE USES: In addition to those disclosures generally permitted under 5 U.S.C. 522a(b) of the Privacy Act of 1974, these records may specifically be disclosed outside of DoD pursuant to 552a(b)(3), including as follows: To designated officers and employees of Federal, State, local, territorial, tribal, international, or foreign agencies, or other publ...
Supervisor Signature. This performance evaluation has been discussed with me, and I certify that I have receivedtraining in the skills listed.
