Legal Reappointment Application

LEGAL REAPPOINTMENT APPLICATION

This Legal Reappointment Application is submitted on behalf of Applicant Name: to Appointing Authority: for reappointment to the position of .

RECITALS

WHEREAS, Applicant was previously appointed to the position of on under reference number .

WHEREAS, Applicant seeks reappointment for a term beginning and ending , and has submitted this application for the Appointing Authority’s consideration.

WHEREAS, the Appointing Authority has statutory and administrative authority to consider and effect reappointments to the subject position and to require information reasonably necessary to its review.

NOW THEREFORE, in consideration of the foregoing recitals and the mutual covenants herein, Applicant and Appointing Authority agree as follows:

1. APPLICATION AND REQUEST

Applicant hereby applies for reappointment to the position identified above and requests that the Appointing Authority consider and act upon this application. Applicant certifies that all information provided in this Application is true, complete, and correct to the best of Applicant’s knowledge and belief, and that no material facts have been omitted.

2. REPRESENTATIONS AND WARRANTIES

Applicant represents and warrants that, at the time of signing:

(a) Applicant holds all licenses, certifications, education, and other qualifications required to perform the duties of the position and will maintain such qualifications during the term of any reappointment; and

(b) Applicant has disclosed to the Appointing Authority any matter that could reasonably be construed as a conflict of interest, impediment to performance, disciplinary action, or criminal conviction. Applicant affirms the following (check applicable boxes and explain any checked items in the Disclosure Explanation field below):

3. SUPPORTING DOCUMENTS

Applicant shall submit, and hereby attests that the following supporting documents accompany this Application:

4. BACKGROUND INVESTIGATION AUTHORIZATION

Applicant expressly authorizes the Appointing Authority to obtain and verify background information necessary to evaluate this Application, including but not limited to academic records, employment history, licensure status, and criminal history checks, to the extent permitted by law. Applicant further releases and holds harmless the Appointing Authority and its agents from liability for obtaining or using such information in connection with the evaluation.

5. FEES AND COSTS

Applicant acknowledges that processing fees, background check fees, or other administrative costs may apply. Unless otherwise stated by the Appointing Authority, Applicant is responsible for payment of such fees prior to final approval. Indicate payment status:

6. PROCESSING AND TIMELINE

The Appointing Authority shall review the Application in accordance with its administrative procedures. Submission of this Application does not guarantee reappointment. Applicant may be contacted for additional information or interviews.

7. CONDITIONS OF REAPPOINTMENT

Any reappointment is subject to final approval by the Appointing Authority, verification of qualifications, clearance of any background checks required by the Appointing Authority, and compliance with applicable rules and policies. The Appointing Authority may impose terms, conditions, or probationary periods as part of any reappointment.

8. CERTIFICATION AND NOTICE REGARDING FALSE STATEMENTS

Applicant certifies under penalty of perjury that the information contained in this Application, including all attachments and supporting documents, is true, accurate and complete. Applicant understands that any material misstatement, omission, or concealment of fact may result in denial of reappointment, disciplinary action, civil liability, or criminal prosecution to the fullest extent permitted by law.

9. NOTICES

All notices required or permitted under this Application shall be in writing and delivered to the addresses set forth below or such other addresses as the parties may designate in writing.

10. AMENDMENTS, WAIVER, GOVERNING LAW, ENTIRE AGREEMENT, SEVERABILITY

This Application may be amended only by written instrument signed by both parties. No failure or delay by the Appointing Authority in exercising any right shall constitute a waiver. This Application shall be governed by the laws applicable to the Appointing Authority. This Application, together with all attachments and referenced documents, constitutes the entire agreement between the parties with respect to the subject matter hereof. If any provision of this Application is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

11. AMENDMENTS AND COUNTERPARTS

This Application may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Signatures transmitted by electronic means shall be deemed original for all purposes.

ACKNOWLEDGMENT

By signing below, Applicant affirms that Applicant has read, understands, and consents to the terms of this Application and the collection and use of information as described herein.

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