"Sample Bona Fide Offer of Employment Letter Template"

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Bona Fide Offer of Employment
Instructions to the Employee
Please follow the instructions below:
1. Read the attached letter carefully. If this letter is not clear, please contact our office immediately
for clarification. (Provide department contact information.)
2. Please check the appropriate space below indicating acceptance or denial of the offer of
employment.
3. Sign and date the form.
4. Return the letter immediately. A phone call may be made to accept or not accept the position.
Refusal to accept the bona fide job offer may affect your temporary income benefits.
Attachment A, pg. 1
OP 70.39
6/19/14
Bona Fide Offer of Employment
Instructions to the Employee
Please follow the instructions below:
1. Read the attached letter carefully. If this letter is not clear, please contact our office immediately
for clarification. (Provide department contact information.)
2. Please check the appropriate space below indicating acceptance or denial of the offer of
employment.
3. Sign and date the form.
4. Return the letter immediately. A phone call may be made to accept or not accept the position.
Refusal to accept the bona fide job offer may affect your temporary income benefits.
Attachment A, pg. 1
OP 70.39
6/19/14
Bona Fide Offer of Employment
Sample Letter
(Print on your Department’s Letterhead)
(Date)
(Employee name)
(Address 1)
(Address 2)
Re: Bona Fide Offer of Employment
Dear (Employee name):
After reviewing the information provided by your doctor, we are offering you the following temporary work assignment.
This assignment is within your capabilities as described by your doctor on the attached Work Status Report (DWC-73). You
will only be assigned tasks consistent with your physical abilities, skills, and knowledge. If any training is required to do this
assignment, it will be provided.
Position title: _______________________________________________________________________________
Description of physical requirements of this position: _______________________________________________
__________________________________________________________________________________________
Location: __________________________________________________________________________________
Duration of assignment: From: (_________) To: (__________)
Work Hours: From: (__________) To: (__________)
Wages: _______________(Hour, Week, Month)
Department: _________________________________
Supervisor: ________________________________
This job offer will remain open for seven (7) calendar days from your receipt of this letter. If you do not respond within seven
(7) calendar days, we will presume you have refused this offer. Refusing this offer may affect your income benefits.
We look forward to your return. If you have any questions, please do not hesitate to contact me (include phone number and
email address).
Sincerely,
(Signature)
(Typed name and title)
EMPLOYEE:
_____ I have read and understand the requirements of the position and accept the position.
_____ I have read and understand the requirements of the position but do NOT accept the position.
________________________________
________________________
Employee’s Signature
Date Signed
Attachment A, pg. 2
OP 70.39
6/19/14
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