Name
Action
Department
Effective Date


 

CANDIDATE'S CERTIFICATION STATEMENT FOR
ACADEMIC PERSONNEL REVIEW

A)

The purpose of this statement is for you to certify that you have been informed of your rights under Section 200 of the Academic Personnel Manual and that you have been provided the opportunity to exercise those rights at the appropriate times during the review process. If you believe you have not been given your rights at any time during this review, you should bring this to the attention of your department chair (and/or indicate it on this form). Your signature on this statement does not necessarily imply that you agree with the department's recommendation. If you have any questions about the review process, please contact Academic Personnel.

I) PREPARATION FOR THE REVIEW (Reference: APM 220-80-c):

a. I was informed of the impending review for this personnel action and of the review process through access to Sections 210-1, 220, and 160 of the APM.

b. I was provided the opportunity to ask questions, to supply information and evidence to be used in the review, to make any desired additions, to suggest names for extramural letters (if required), and to provide, in writing, names of persons, for reasons set forth by me, may not provide objective evaluations.

c. I had the opportunity to inspect all documents to be included in the file.

Candidate's Initials
Date

II) BEFORE THE DEPARTMENTAL RECOMMENDATION (Reference: APM 220-80-d):

d. I had the opportunity to receive an oral summary or, if requested, a redacted copy of the substance of the confidential review records (extramural letters, departmental ad hoc report) in the file.

e. I had the opportunity to provide a written statement at least five working days before the departmental meeting for inclusion in this file in response to or commenting upon materials in the file.

Candidate's Initials
Date

III) AFTER THE DEPARTMENT RECOMMENDATION (Reference: APM 220-80-e):

f. I was informed orally of the department recommendation and of the substance of the department evaluation under each of the applicable criteria and/or I had the opportunity to receive, if requested, a copy of the department letter and vote.

g. I had the opportunity to address a written response to the chair or dean within five working days of being informed of the department recommendation.

Candidate's Initials
Date
B)

Please indicate which of the following documents, if any, you have either requested/received or provided for inclusion in the file:

I have requested/received:

__ a redacted copy of confidential material in the file (see"d")
__ a copy of the department letter and vote (see "f")

I have provided:

__ a list of suggested names of extramural letters (see"b")
__ a list of reviewers I consider biased and my stated reasons (see"b")
__ a written comment on materials in the file (see "e")
__ a written response to the department recommendation (see "g"

I certify that all of the above statements are correct:

Candidate's Signature____________________ Date____________


Chair's Signature _____________________Date ___________

THE FORM IS TO BE INCLUDED IN THE REVIEW FILE

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