For Office Use Only: (Complete if Applicable)
___ Interview not offered: (check one) ___ Employment not offered: (check one)
___ Removed self from consideration ___ Others more qualified:
___ Lacked basic qualifications for the job ___ No positions available
_____________________________________________________________________
Interview date: _________________
Interviewer _________________
Offer date: _________________
Hiring Authority _________________
Revised 6/87, 8/96, 5/97, 6/97, 7/97, 2/01, 4/04, 8/05, 1/06, 9/06, 1/07, 7/07, 11/07, 4/08, 9/08, 7/09, 9/11, 2/12, 11/16, 4/17
Title 404 NAC Chapter 4-04