Kentucky Public Human Resources Association

KPHRA Certification Experience Report 2018 This form is used to report job experience for credit in the Kentucky Public Human Resources Association public personnel administrator certification program. Candidates for certification should be familiar with the official guidelines and standards of the program before completing the form. Copies of the guidelines may be acquired by contacting Elizabeth Schepens at eschepens@klc.org. This form must be submitted by March 30th this year, for credit earned during the preceding calendar year (January 1 - December 31, 2017).

2. Period Covered by this Report (January 1-December 31, unless job change or other exigency requires partial year report):

4. Is there an official job description pertaining specifically to your position?

Yes
No

6. List below all major duty areas you carried during this reporting period, the number of months in the reporting period during which you carried these duties, and the average number of hours PER MONTH you worked at performing those duties. A master list of personnel functions is available from the governing university.

A. Personnel

List below all major duty areas you carried during this reporting period, the number of months in the reporting period during which you carried these duties, and the average number of hours PER MONTH you worked at performing those duties. A master list of personnel functions is available from the governing university.

B. Non-Personnel

C. Personnel / Non-Personnel Ratio

1. Enter total of all hours from Section 6-A-9 and Section 6-B-7 above
2. Enter total hours from Section 5
If line C-1 and line C-2 are different, attach explanation for difference.
3. a) Enter hours from section 6-A-9 here
3. b) Enter hours from Section 5 here
3. c) Divide line C-3-a by line C-3-b and enter result here

D. HR Related Education Earned Outside KPHRA Conferences and Workshops

Attach any HR related education you attended during the calendar year covered by this report (for years 2015 and after) that was not provided by KPHRA that you would like to submit for consideration to be counted toward your certification. Up to 35 hours for certification or 25 hours for recertification may be counted for HR related education not provided by KPHRA.

or each educational session, please list the following:

Date, Number of Hours, Session name and topic(s) covered, the presenter, the host organization and location. Documentation or other materials that explain, show, or describe the education session is required.

The Certification Committee will review your request and has final authority to approve or deny granting KPHRA credit for education received from outside sources.

Attestation:

I understand that any willful misrepresentation of my work or educational experience may result in removal from the certification program and revocation of certification if it has already been granted. Typing your name below will serve as your signature.

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