<p> VOLUNTARY APPOINTMENT CHECKLIST- WSU DEPARTMENT </p><p>Name Banner ID Date OFA Received ______</p><p>Rank Requested Position # Degree Type: MD DO PhD Other Degree Type______Effective Date MI Professional Department License #: Expiration Date</p><p>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</p><p>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</p>