HR 4.30-A (rev. 4/95)
EXCHANGE PROGRAM APPLICATION
This form should be completed by an employee wishing to participate in the Employee Exchange Program.

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Employee's Name: ____________________________ Supervisor's Name: _______________________

Telephone: _________________________________ Telephone: _____________________________

Class Title: _________________________________ Division: _______________________________

Working Title: ______________________________ Department: ____________________________

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Description of Current Duties:
 
 
 
 

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Summary of Employee's Education & Experience:

(Highlight those qualifications that suit the employee to the desired exchange experience.)
 
 
 
 
 

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Description of Exchange Position Desired:
 
 

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Times & Dates Available for Exchange:
 
 

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Employee Signature: __________________________________________ Date: __________________

Supervisor Approval: _________________________________________ Date: __________________

Dept. Head Approval: ________________________________________ Date: __________________

Send completed form to Human Resources.