Voluntary Appointment Checklist- Wsu Department

VOLUNTARY APPOINTMENT CHECKLIST- WSU DEPARTMENT

Name Banner ID Date OFA Received ______

Rank Requested Position # Degree Type: MD DO PhD Other Degree Type______Effective Date MI Professional Department License #: Expiration Date

Primary Affiliation Board Cert # Expiration Date Document Candidate Affiliate WSU Dept. OFA Completed Checklist as cover page for packet Assignment Form Candidate completes 1st four lines

WSU Dept. completes remainder Affiliate Chair Letter (address teaching quality, quantity, duration @ WSU/prior institutions) WSU Chair Letter (Chair may ask for waiver of external letters of recommendation if all of training was done at WSU ) Letters of Recommendatio n 1 letter required (may be internal) Affiliate Chair’s letter (if applicable) counts as 1 letter of recommenda tion Letter of Offer WSU Policies: Acknowledgement that the Student Mistreatment, the Professionalism (Code of Conduct) and the Student Confidentiality policies have been reviewed Office of Faculty Affairs and Professional Development_WSU Dept_Voluntary Appointment Checklist_ 2.13.2017 Curriculum Vitae (in required format) For Voluntary CV requirements, go to: http://facaffairs.me d.wayne.edu/volunt ary_faculty_appoin tments.php Photocopy of Michigan license (if applicable) https://W2.lara.sta te.mi.us/val/licens e/search Photocopy of Board Certification(s) (if applicable) MD: http://www.cer tifacts.org/spe cialties.html DO: http://www.ost eopathic.org/o steopathic- health/Pages/f ind-a-do- search.aspx Official Transcript (Ph.D. faculty without MI license only); Notarized copies acceptable for foreign graduates only Faculty Data Sheet Background Check Request SUBMISSION INFORMATION WSU departments should email complete packet as a .pdf to: [email protected] Submitted by: Phone Email To be completed by the Office of Faculty Affairs Only Current Appointment Yes No Prior Appointment Yes No Date File Pulled Approved Denied Tabled E/C Review Date E/C Decision Corrections Required Required Date results Date requested: Background Check Not Required received: (Requested by WSU Dept.) Requested by: Fully Executed Welcome Letter ______LOO Recd. Sent AAMC FAMOUS Banner Entry Date OFA Specialist Form Processing Date Office of Faculty Affairs and Professional Development_WSU Dept_Voluntary Appointment Checklist_ 2.13.2017 Office of Faculty Affairs and Professional Development_WSU Dept_Voluntary Appointment Checklist_ 2.13.2017