"Form for Acknowledgement of Required Professional Credential" - Georgia (United States)

Form for Acknowledgement of Required Professional Credential is a legal document that was released by the Georgia Department of Juvenile Justice - a government authority operating within Georgia (United States).

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Acknowledgement of
Required Professional Credential
I acknowledge that I am required as part of my job duties to maintain a
professional credential.
I understand that:
• Any costs associated with the maintenance of a professional credential
will be my responsibility.
• I am responsible for maintaining my professional credential in good
standing.
• I must provide a copy of the credential and all renewals to my supervisor.
• I must immediately notify my supervisor of any notice from any
licensing/certifying agency that may affect my professional credential, and
provide a copy of the action.
• I must immediately notify my supervisor of any revocation, suspension,
sanction, or any other action affecting my professional credential.
• Employees with a professional credential not in good standing (e.g.,
suspension, sanctions, restrictions, expiration) which limits their ability to
perform assigned duties will be subject to forfeiture of position.
• Employees whose professional credentials have been revoked shall be
deemed to have forfeited the position.
______________________________
______________________________
Employee
Witness
(Print Name)
(Print Name)
______________________________
______________________________
Employee’s Signature
Witness’s Signature
______________________________
______________________________
Date
Date
Acknowledgement of
Required Professional Credential
I acknowledge that I am required as part of my job duties to maintain a
professional credential.
I understand that:
• Any costs associated with the maintenance of a professional credential
will be my responsibility.
• I am responsible for maintaining my professional credential in good
standing.
• I must provide a copy of the credential and all renewals to my supervisor.
• I must immediately notify my supervisor of any notice from any
licensing/certifying agency that may affect my professional credential, and
provide a copy of the action.
• I must immediately notify my supervisor of any revocation, suspension,
sanction, or any other action affecting my professional credential.
• Employees with a professional credential not in good standing (e.g.,
suspension, sanctions, restrictions, expiration) which limits their ability to
perform assigned duties will be subject to forfeiture of position.
• Employees whose professional credentials have been revoked shall be
deemed to have forfeited the position.
______________________________
______________________________
Employee
Witness
(Print Name)
(Print Name)
______________________________
______________________________
Employee’s Signature
Witness’s Signature
______________________________
______________________________
Date
Date