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University of California Davis Health System Resident Medical Staff EMPLOYMENT CERTIFICATION FORM Name PPSID Date of Birth Academic Department Position Code Title Salary per Month Percent Time 100 Start Date 0800 hrs End Date 0800 hrs Status Academic Student Employee I certify that the foregoing personal data are correct and I accept the position on the terms specified above and in my letter of appointment contingent upon the availability of funds and formal Administrative or Regent approval. I recognize the salary is subject to such deductions as may be required pursuant to applicable laws and regulations. In the event that my service does not continue throughout the term if any be specified the salary due me will be based upon actual service performed and I will return to the University such part of my salary as is not actually earned on this basis. Appointments are for one year. Reappointment is contingent upon performance and funding availability. Resident Signature Human Resources Representative Signature Date Office of Record Personnel File located in Human Resources Resident Program. In the event that my service does not continue throughout the term if any be specified the salary due me will be based upon actual service performed and I will return to the University such part of my salary as is not actually earned on this basis. Appointments are for one year. Reappointment is contingent upon performance and funding availability. Appointments are for one year. Reappointment is contingent upon performance and funding availability. Resident Signature Human Resources Representative Signature Date Office of Record Personnel File located in Human Resources Resident Program. In the event that my service does not continue throughout the term if any be specified the salary due me will be based upon actual service performed and I will return to the University such part of my salary as is not actually earned on this basis. Appointments are for one year. Reappointment is contingent upon performance and funding availability. Resident Signature Human Resources Representative Signature Date Office of Record Personnel File located in Human Resources Resident Program.