Supervisor attestation form

  = Required

Submit the attestation form below after you have obtained the Customer Information Policy training certification form from each of your employees required to take the Customer Information Policy training.

Note: Customer Information Policy training certification forms may be submitted to you electronically as an email attachment or as a printed document. Retain the employee certification forms in your files for future audits.

 Date is required. Date

December 2024

 Supervisor name is required. Supervisor name

 Email address is required.A valid email address is required. Email address

 Company name is required. Company name

 Number of employees who completed the training is required. Number of employees who completed the training

 Please check the box to continue.I certify that the above statements are true and correct to the best of my knowledge. I understand that providing a false statement may disqualify me for receiving benefits.