Transaction Number Date of Certificati
CERTIFICATION AND APPOINTMENT REPORT oo sa
In response to your requisition for employees, the names of the following eligibles are submitted. Each person listed below has been notified
of his certification and instructed not to communicate with you until you request him to do so. You probably will find it advisable to interview all
eligibles certified. Appointment can be completed by indicating with a check mark in the proper column below the action taken. Return the white
copy to the Department of Civil Service. Retain the blue copy for your own files.
INTERVIEW APPOINTMENT
Effective
Rank NAME ADDRESS Notified Appeared Interested Selected Bg tae
ate
Yes No Yes No Yes No Yes No
Cine
This certification terminates the provisional appointments of the following named individuals as Of -...-...---..cc cece cco cececsceeeeeesceseseebesbelseseteeteeteeeeeeeeeeeeeec ee.
Date Signature of Supervisor Date Signature of Appointing Authority
FOR USE BY THE DEPARTMENT OF CIVIL SERVICE
Certification Notices Follow-up Letters Action Recorded
Approved Sent Sent
By 2 Date By Date Bes “. BY Date By Date
Date Signature of Director of State Civil Service