EMPLOYEE’S CERTIFICATION. Employee HEREBY CERTIFIES THAT:
EMPLOYEE’S CERTIFICATION. Employee to perform services as (mark one): Name Chaplain Fireman ___Dentist Registered Nurse Licensed Practical Nurse Social Security # L icensed Physician Psychologist Employed by Certified Oral or Manual Interpreter for Deaf Person Employee’s Signature Teacher or Instructor of an evening or night course or program Date Professional holding a doctoral or masters degree from an accredited college or university
EMPLOYEE’S CERTIFICATION. I certify that all of the statements made by me in this application for paid benefits by my publicly funded employer are true and complete to the best of my knowledge and belief and that such statements have been honestly presented. I understand that providing any false or misleading information on this application shall be fully sufficient grounds to refuse to grant sick bank days to me, or, if such days have already been provided to me, to discipline me in accordance with the collective bargaining agreement and/or Maine law. Signature: Print Name: Date: APPENDIX C: ASSOCIATION SICK LEAVE BANK CERTIFICATION FORM CERTIFICATION OF HEALTH CARE PROVIDER FOR CATASTROPHIC ILLNESS (This form should be used only if there is not a current FMLA/FML medical certification on file covering the request for sick leave bank.)
EMPLOYEE’S CERTIFICATION. I certify that on I will/did take hours of leave for the following purpose: to participate in school activities directly related to the educational advancement of my son or daughter; to accompany my son or daughter to routine medical or dental appointments such as check-ups or vaccinations; to accompany an elderly relative to routine medical or dental appointments for other professional services related to the elder’s care. Name: Date:
EMPLOYEE’S CERTIFICATION. 1. I certify that I have read this entire agreement, or to the best of my knowledge, information and belief (if applicable) this agreement has been read to me, and I understand all the contents of this agreement as well as the full legal significance and consequences of entering into this agreement to compromise and release my workers’ compensation benefits under the Pennsylvania Workers’ Compensation Act only.
EMPLOYEE’S CERTIFICATION. Employee hereby certifies receipt of a copy of this Agreement and certifies that the contents hereof are understood by Employee. Employee certifies that this Agreement fairly represents the agreement reached between the parties.
EMPLOYEE’S CERTIFICATION of Truth and Accuracy of Materials and Representations. Employee does hereby certify and declare that Employee’s application materials, including but not limited to resumes and curriculum vitae submitted in support of candidacy for employment are a true and accurate representation of Employee’s education, credentials, qualifications, experience, and background and acknowledges that falsification of employment applications or documents submitted to the NSHE, or making other false or fraudulent representations in securing employment is prohibited. Falsification or misrepresentation of education, credentials, qualifications, experience, or background and/or evidence that degrees offered in support of candidacy for employment have been issued from non-accredited institutions, in Employer’s sole and absolute discretion, invalidates the employment contract and voids this Agreement and results in immediate termination for cause.
EMPLOYEE’S CERTIFICATION. I understand and agree to the following:
EMPLOYEE’S CERTIFICATION. Employee to perform services as (xxxx one): NAME Chaplain Fireman Dentist Registered Nurse Licensed Practical Nurse Licensed Physician Psychologist SOCIAL SECURITY # Certified Oral or Manual Interpreter for Deaf Persons EMPLOYED BY Teacher or Instructor of an evening or night course or program NO. OF CREDIT HOURS
EMPLOYEE’S CERTIFICATION. (I have read and understand the terms of this agreement.) • I agree that violation of any of the foregoing conditions may require immediate return of the assets Printed Name: Employee ID#: Signature: Date: Phone Number: Asset Information CD # Type Item Model Serial # RFID # Comment Special Provision:
