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Policy #2001 Professional Licensing Attachment #1 GEORGIA DEPARTMENT OF HUMAN RESOURCES ACKNOWLEDGEMENT OF RESPONSIBILITY TO MAINTAIN CURRENT LICENSE, CERTIFICATE OR REGISTRATION NAME:_________________________________________________________________________ DHR ORGANIZATIONAL UNIT:___________________________________________________ JOB TITLE:_____________________________________________________________________ TYPE OF REQUIRED LICENSE/CERTIFICATE/REGISTRATION:_____________________ ________________________________________________________________________________ EXPIRATION DATE:_____________________________________________________________ I understand that it is my responsibility to obtain and maintain a currant license, certificate or registration whennecessary or appropriate. I understand that I am to advise my supervisor or human resource/personnel office of any problem encountered regarding my license, certificate or registration. I further understandthat FAILURE to maintain a currant license, certificate or registration will result in separation from employment. ______________________________ Signature of Employee ______________________________ Date c: Supervisory File Other Appropriate Files Form #2001-1 Republished 7/99
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