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Request for Training

REQUEST FOR TRAINING

Name:

Employee ID#:

Date:

Home Address:

Location Code:

Position:

Employee’s normal work hours:

Substitute for position required:

Seminar/training activity you wish to attend
* Attach brochure/information defining seminar/training activity you wish to attend.
* Attach an updated copy of your Professional Development Plan. Supervisors maintain in the staff’s file in the county.

Date/time leaving:

Date/time returning:

Registration fee cost:

Requesting overnight stay?

Staff Registered/Central Office Staff Needs to Register:

Willing to share occupancy?

If yes, list name

Briefly describe why you want to attend:

Briefly describe how you would use the information in your job:

Are you willing to compile information to share with other staff?

Is this form: Staff initiated/ Supervisor initiated

Staff development requirement:

_____________ ______________________________________________

Date Employee Signature

Request approved ___________________ Request denied _______________________

_____________ ____________________________________________

Date Supervisor Signature

CENTRAL OFFICE USE ONLY:

Request approved ___________________ Request denied ______________________

_____________ ___________________________________________

Date Approving Signature

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

April 3, 2017 11:42 am EDT

Request for Training Uploaded by Rob Everly Everly - itadmin@ncwvcaa.org IP 67.52.21.30