STATE OF NEVADA
STATE OF NEVADA
1
DCFS Staff Acknowledgement of Client’s Rights and Responsibilities
I acknowledge that I have received training from my supervisor about client’s rights and responsibilities and that I have read and understand the DCFS CRR – 2 Client’s Rights and Responsibilities Policy dated _________________________.
Insert Revision Date of Policy
I understand this signed statement will be placed in my Agency Personnel File as confirmation that I have received this training and that I understand the policy and practice requirements.
____________________________________ ______________________________________
Print Employee’s Name Employee’s Signature
____________________________________
Date
By affixing my signature below, I confirm I am the supervisor of the above noted DCFS employee and that I have trained this DCFS staff member on the current Client’s Rights and Responsibilities Policy. I further confirm that the DCFS staff member has demonstrated an understanding of this policy.
The training provided was: Initial Training ________________________________ (Date)
Annual/Refresher Training _______________________ (Date)
____________________________________ _______________________________________
Supervisor’s Signature Date
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BRIAN SANDOVAL
Governor
Richard Whitley
Director
KIRSTEN COULOMBE
Administrator
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Department of Health and Human Services
Division of Child and Family Services
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