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Affidavit / Act / Seal / Health insurance / Insurance / Certified copy / Eschatocol / Notary / Law / Notary public


Chabot-Las Positas Community College District Office of Human Resources Part-Time Faculty Medical Benefits Affidavit for Enrollment and Authorization for Payroll Deductions TO BE COMPLETED BY PART-TIME FACULTY I hereby c
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Document Date: 2014-08-04 19:27:27

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File Size: 27,95 KB

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medical insurance / /

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Notary Public TO BE COMPLETED BY DIVISION / Chabot-Las Positas Community College District office of Human Resources Part-Time Faculty Medical Benefits Affidavit for Enrollment and Authorization / /

Person

Dean Load Verified / /

Position

Officer / /

ProvinceOrState

California / On __________________________Before Me / /

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