COVID Policy Ack Form

Families First Coronavirus Response Act

Acknowledgement Statement
I, the undersigned, acknowledge that I have received and reviewed the Town of Burgaw's Families First Coronavirus Response Act Policy.

I also understand that the Town of Burgaw reserves the right to change, modify, amend, or delete any policies/procedures and benefits in this policy at any time with or without notification.
Employee Signature

Clear
Date

MonthDayYear
Date
Employee Name (Please print)
Title
This signed statement must be kept in the above named employee's personnel file.
Should be Empty:

Families First Coronavirus Response Act