Form Sr 2a Pfr - Ccs Personnel File Review

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CCS PERSONNEL FILE REVIEW
GH NAME:
AUDIT PERIOD:
CCS AND FIRST LINE SUPERVISORS
EXPERIENCE
VERIFIED (Y/N)
EDUCATION
COMMENTS
WORKER NAME
F/P
CAIC
Reported
Verified
Assoc.
Reported
Verified
submitted
submitted
SR 2A PFR (12/02)
Page ____ of ____

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