NEVADA DEPARTMENT OF CORRECTIONS

REQUEST FOR REHIRE/REINSTATEMENT

To be completed by employee:

EMPLOYEE’S NAME: __________________________________________________________

POSITION TITLE: _____________________________________________________________

INSTITUTION: ____________________________ BUDGET ACCOUNT #: ___________

FINAL APPROVALS:

(To be completed by appropriate DOC personnel)

( ) Approved

( ) Denied _________________________________________ _____________

Signature of Warden or Division Head Date

( ) Approved

( ) Denied _________________________________________ _____________

Personnel Officer III Date

( ) Approved

( ) Denied _________________________________________ _____________

Signature of Asst. Director / Medical Director Date

( ) Approved

( ) Denied _________________________________________ _____________

Signature of Director (If Applicable) Date

FOR PERSONNEL DIVISION USE ONLY:

Effective date of rehire/reinstatement __________________. (To be assigned once final approval(s) received.)

Position number assigned: _______________.