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Tenet HealthSystem
APPLICATION FOR TRANSFER/PROMOTION
INSTRUCTIONS: Employee: Please complete area (#1). Obtain current supervisor's signature (#2). Return this form to
your current Human Resources Department for processing (#3). Current HR dept. will fax this form to the HR Dept. where
transfer is requested.
1.
_________________________________________________________________________________________________________
NAME (Please Print)
Facility or Hospital where currently employed
Current Position
Employment Status
Current Rate of Pay
Date of Employment
Home Address
Telephone Number
POSITION APPLYING FOR: ________________________________ FACILITY: _____________________________
Employment Status -- FT/PT/Per Diem.
Reason you are interested in this position:_______________________________________________________________________
PAST WORK HISTORY: (not including current position; you may attach a current resume if you like)
______________________________________________________________________________________________________
COMPANY NAME
POSITION
Hire Date
REASON FOR LEAVING
______________________________________________________________________________________________________
COMPANY NAME
POSITION
Hire Date
REASON FOR LEAVING
Employee Signature: _________________________________________________
Date: ______________________
(Note: If accepted for transfer/promotion, I give permission to release my employee health file to the receiving Tenet facility.
If denied for transfer/promotion, I give permission to release the reason(s) to my current facility)
#2.Current Supervisor’s Acknowledgement:__________________________________ Date________________
Comments:
________________________________________________________________________________________________
#3. Current H.R. Dept. Signature: ___________________________________
Eligible to transfer Not eligible
Comments:
________________________________________________________________________________________________
#4.Transfer Facility/Hospital: *
We are pleased to offer you the following position:
Title: ___________________________ Dept. _____________________ Status: _________ Rate of Pay: _________________
H.R./Facility Rep’s. Signature: ____________________________________ Print Name: ________________________________
Offer accepted. Employee’s signature: __________________________________________ Date: _____________________
Offer of employment not extended. Comments: _____________________________________________________________
Anticipated Transfer Date: ___________________________ (See HR Policy 209 for guidance)
Date Approved: _____________________ Date Not approved: _______________________.
Initials/Signature
Initials/Signature
Comments: ________________________________________________________________________________________________
Routing: Human Resources ⇒Employee ⇒ Supervisor ⇒ Employee ⇒Current Facility HR ⇒ Receiving Facility HR
_________________________________________________________________________________________________________
transfer.doc
Updated 01/10/2007