EMPLOYMENT ACKNOWLEDGEMENT FORM

The ORIENTATION PACKET has important information about employment with District 2 Public Health.

         My signature below acknowledges that I have received the ORIENTATION PACKET, and that I
         understand it is my responsibility to read and comply with the guidelines described in it. I understand
         that, if I have questions not answered in the ORIENTATION PACKET, I should

· Asks questions at orientation

· Contact my supervisor

· Contact my human resource/personnel representative

· Refer to the Department of Human Resources website

         I UNDERSTAND THAT THIS ORIENTATION PACKET IS NOT A CONTRACT OF
         EMPLOYMENT OR A LEGAL DOCUMENT, AND IS NOT TO BE INTERPRETERED AS
         SUCH.
         District 2 Public has the right to change information in this ORIENTATION PACKET at any
         time or for any reason without prior notice.

PLEASE COMPLETE BELOW:

EMPLOYEE’S NAME (Please print): ___________________________________

EMPLOYEE’S SIGNATURE: _________________________________________

WORK LOCATION & ADDRESS: ____________________________________

___________________________________________________________________

DATE: __________________

Please read, sign and date this form. Make a copy to be kept with your orientation packet and give

a copy to your supervisor for their supervisory file.

ORIGINAL GOES TO HUMAN RESOURCES TO BE PLACED IN PERSONNEL FILE