NIH Merit Promotion CertificateISSUED BY:

ISSUED TO:

TYPE OF APPT: Permanent TemporaryNTETENURE:

VACANCY ANNOUNCEMENT #:

CERTIFICATE #:

TITLE/SERIES/GRADE:# OF VACANCIES:PROMOTION POTENTIAL: DUTY LOCATION:

DATE CERTIFICATE ISSUED: DATE CERTIFICATE EXPIRES:

For additional information please contact: Phone:

SIGNATURE OF ISSUING HR SPECIALIST:

The candidates listed below are referred for your consideration under the NIH Merit Promotion Program. Please consider carefully the qualifications of each candidate. You may select any of the referred candidates.

ACTION* NAME/ADDRESS/PHONE NUMBER REMARKS/EOD DATE

SIGNATURE OF SELECTING OFFICIAL TITLE DATE

SIGNATURE OF HR SPECIALIST UPON RECEIPT OF RETURNED CERTIFICATE DATE

SIGNATURE OF AUDITING HR SPECIALIST AUDIT DATE

*Use the following symbols in the Action Column: A=Selected; NS=Not Selected; D=Declined

NIH 2265-1 (Rev. 5/14)