Honeoye School - Occupational Therapist (Lateral Transfer Only)

TRANSFER REQUEST

Candidate Instructions: Complete Section 1 and send to the Appointing Authority with a current resume.

FULL NAME OF EMPLOYEE:

SECTION 1

TO BE COMPLETED BY EMPLOYEE REQUESTING TRANSFER

EMAIL ADDRESS:

PHONE NUMBER:

TRANSFER REQUESTED FROM:

CIVIL SERVICE AGENCY:

CURRENT EMPLOYER (COUNTY, CITY, TOWN, VILLAGE, SCHOOL DISTRICT OR OTHER)

CURRENT JOB TITLE:

I GIVE MY CONSENT FOR ONTARIO COUNTY DEPARTMENT OF HUMAN RESOURCES TO ACQUIRE MY CIVIL SERVICE EMPLOYMENT RECORDS.

SIGNATURE:

DATE:

PRINTED NAME:

SECTION 2

BE COMPLETED BY

TO

TRANSFER REQUESTED TO:

DEPARTMENT

NAME OF COUNTY, CITY, TOWN, VILLAGE, SCHOOL DISTRICT OR OTHER:

NAME OF DEPARTMENT:

POSITION REQUESTING TO FILL:

APPROVAL OF DEPARTMENT HEAD:

DATE:

PRINTED NAME OF DEPARTMENT HEAD:

TITLE:

(SPACE BELOW FOR USE BY ONTARIO COUNTY DIRECTOR OF HUMAN RESOURCES)

ONTARIO COUNTY DIRECTOR OF HUMAN RESOURCES ACTION:

SECTION 3

oAPPROVED

oDISAPPROVED

BY:

TITLE:

DATE: