APPRENTICE PERMIT APPLICATION. Sex--Male Female Birthday Social Security #
|
|
- Harriet Banks
- 5 years ago
- Views:
Transcription
1 APPRENTICE PERMIT APPLICATION The $ non-refundable fee must accompany this application. Each applicant must provide the following: proof of GED or high school graduation, training schedule and a work history on the form provided. Verification form if applicable must be attached. Checks or money orders shall be made payable to the Alabama Board of Hearing Instrument Dealers. This application must be filled out completely and accurately. Please type or print in dark ink. Applications which are not complete or legible will be returned. All signatures, where required, must be original signatures; no computer generated signatures will be accepted. LAST NAME FIRST MI DATE Sex--Male Female Birthday Social Security # Home / Home Phone Are you a U.S. citizen or legally present in the United States? Yes No If you answered YES: (1) Provide a legible copy of document from attached List A or other document that demonstrates U. S. citizenship or nationality Name of Document Provided: If you answered NO: (2) Provide a legible copy of document from attached List B or other document that demonstrates lawful presence in the United States Name of Document Provided: Do you have a contagious or infectious disease? (If yes, please attach explanation) Yes No Have you been convicted of a felony? (If yes, please attach explanation) Yes No Have you ever been licensed in any state(s) to select fit or sell hearing aids? Yes No (If yes, verification form must be completed by state(s) you every held/hold a license) List state(s) including Alabama that you have held or currently hold a license _ Have you ever had a license revoked or suspended? (If yes, please attach explanation) Yes No Name of person with a current Alabama dispenser's license who is responsible for your supervision. SUPERVISOR'S NAME SUPERVISOR'S SIGNATURE SUPERVISOR S LICENSE NO. APPLICANT'S NAME APPLICANT S SIGNATURE Sworn to and subscribed before me, this, the of 20. (NOTARY PUBLIC SIGNATURE AND STAMP)
2 APPRENTICE TRAINING SCHEDULE _ Apprentice Name _ Sponsor s Name Sponsor s Permit Number License Number Training Subject Acoustics: General, Tone Pitch, Hearing & Speech The Human Ear: External, Middle and Internal Date Training Began Date Training Completed Hours Initials in the space below indicate that training has been completed Sponsor s Initials Apprentice s Initials The Hearing Process; Conductive Disorders Pure Tone: Theory, Air and Bone Conduction Speech Audiometry The Audiogram and the Auditory Area Introduction to Electronics Hearing Aids: History Hearing Aids: Components & Characteristics Hearing Aid Fitting and the Earmold Delivery and Checkup Total Hours Training The above academic and practical subjects have been covered as a course for the training of this apprentice in the practice of fitting and selling hearing aids: Signature of Sponsor Date Signature of Apprentice Date
3 DUPLICATE LICENSE REQUEST FORM Submit the required duplicate license fee for each duplicate license renewal or additional license request. Duplicate #1 Duplicate #2 City State Zip City State Zip Duplicate #3 Duplicate #4 City State Zip City State Zip Duplicate #5 Duplicate #6 City State Zip City State Zip
4 VERIFICATION OF LICENSURE This form must be completed by the state regulatory agency in each state from which you hold or ever held a license to select, fit or sell hearing aids. APPLICANT LAST NAME APPLICANT FIRST NAME LICENSE NUMBER DATE LICENSE ISSUED Profession in which license was issued Current Not Current If not, current, explain briefly why not: License issued on the basis of: Are there any records of disciplinary action? Yes No If yes, list reasons for disciplinary action: I hereby certify that this information is correct to the best of my knowledge and that based on records available to me the applicant was competent to practice in this state. SEAL Name of Agency Signature of Official Title
5 WORK HISTORY FORM Begin with your PRESENT employment. List in REVERSE ORDER all periods of employment, including each job or title change, and any periods of unemployment. If needed, include a continuation page(s) to ensure there are no breaks in your work history record. Current or Last Employer: From: To: Telephone (Daytime) Type of Business: Official Job Title: Describe Your Duties: Previous Employer: From: To: Telephone (Daytime) Type of Business: Official Job Title: Describe Your Duties: Previous Employer: From: To: Telephone (Daytime) Type of Business: Official Job Title: Describe Your Duties: List any additional employment on the back of this form
6 LIST A PROOF OF CITIZENSHIP Code of Alabama 1975, Section (g) From Act (1) A driver's license or non-driver's identification card issued by the Alabama Department of Public Safety or the equivalent governmental agency of another state within the United States, provided that the governmental agency of another state within the United States requires proof of lawful presence in the United States as a condition of issuance of the driver's license or non-driver s identification card. (2) A birth certificate indicating birth in the United States or one of its territories. (3) Pertinent pages of a United States valid or expired passport identifying the person and the person's passport number, or the person's United States passport. (4) United States naturalization documents of the number of the certificate of naturalization. (5) Other documents or methods of proof of United States citizenship issued by the federal government pursuant to the Immigration and Nationality Act of 1952, as amended. (6) Bureau of Indian Affairs card number, tribal treaty card number, or tribal enrollment number. (7) A consular report of birth abroad of a citizen of the United States of America. (8) A certificate of citizenship issued by the United States Citizenship and Immigration Services. (9) A certification of report of birth issued by the United States Department of State. (10) An American Indian card, with KIC classification, issued by the United States Department of Homeland Security. (11) Final adoption decree showing the person's name and United States birthplace. (12) An official United States military record of service showing the applicant's place of birth in the United States. (13) An extract from a United States hospital record of birth created at the time of the person's birth indicating the place of birth in the United States. (14) AL-verify. (15) A valid Uniformed Services Privileges and Identification Card. (16) Any other form of identification that the Alabama Department of Revenue Authorizes, through an administrative rule promulgated pursuant to the Alabama Administrative Procedure Act, to be used to demonstrate or confirm a person's United States citizenship or lawful presence in the United States, provided that the Identification requires proof of lawful presence in the United States as a condition of issuance.
7 LIST B PROOF OF LAWFUL PRESENCE OF NON-CITIZEN Code of Alabama l975, Section (10) (1) A valid, unexpired Alabama driver's license. (2) A valid, unexpired Alabama nondriver's identification card. (3) A valid tribal enrollment card or other form of tribal identification document bearing a photograph or other biometric identifier, if issued by an entity that requires proof of lawful presence in the United States before issuance. (4)) Any valid United States federal or state government issued identification document bearing a photograph or other biometric identifier, issued by an entity that requires proof of lawful presence in the United States before issuance. (5) A foreign passport with an unexpired United States Visa and a corresponding stamp or notation by the United States Department of Homeland Security indicating the bearer's admission to the United States. A foreign passport issued by a visa waiver country with the corresponding entry stamp and unexpired duration of stay annotation or an I-94W form by the United States Department of Homeland Security indicating the bearer's admission to the United States.
E-VERIFY NOTICE (RFP)
Consultant s E-Verify Clause and Affidavit (No Bid Contracts) Effective January 1, 2012, this notice shall be provided to all consultants and others who provide professional services to the University
More informationALABAMA BOARD OF MEDICAL EXAMINERS P.O. Box 946 / Montgomery, AL / (334)
Page 1 of 6 ALABAMA BOARD OF MEDICAL EXAMINERS P.O. Box 946 / Montgomery, AL 36101-0946 / (334) 242-4116 APPLICATION FOR REINSTATEMENT OF PHYSICIAN ASSISTANT/ANESTHESIOLOGIST ASSISTANT LICENSE 1. NAME
More informationALABAMA BOARD OF MEDICAL EXAMINERS 540-X-3 APPENDIX E ALABAMA BOARD OF MEDICAL EXAMINERS P.O. Box 946--Montgomery, AL (334)
ALABAMA BOARD OF MEDICAL EXAMINERS 540-X-3 APPENDIX E ALABAMA BOARD OF MEDICAL EXAMINERS P.O. Box 946--Montgomery, AL 36101 (334) 242-4116 540-X-3, Appendix E Page 1 of 7 APPLICATION FOR A CERTIFICATE
More informationInstructor Information for Endorsement
SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION SOUTH CAROLINA BOARD OF COSMETOLOGY POST OFFICE BOX 11329 COLUMBIA, SOUTH CAROLINA 29211-1329 (803) 896-4588 Email: BoardInfo@llr.sc.gov Instructor
More informationAPPLICATION FOR CERTIFICATION AS A BIOLOGICAL WASTEWATER TREATMENT OPERATOR
South Carolina Department of Labor, Licensing and Regulation South Carolina Environmental Certification Board P.O. Box 11409 Columbia, SC 29211 Phone: 803-896-4430 Fax: 803-896-4424 www.llr.state.sc.us/pol/environmental/
More informationALABAMA DENTAL HYGIENE BOARD EXAM LICENSURE APPLICATION
ALABAMA DENTAL HYGIENE BOARD EXAM LICENSURE APPLICATION 1. An unmounted passport photograph, 2x2, of applicant taken not more than six months before date of application, must be securely pasted, NOT STAPLED,
More informationAPPLICATION FOR CERTIFICATION AS A WELL DRILLER
South Carolina Department of Labor, Licensing and Regulation South Carolina Environmental Certification Board P.O. Box 11409 Columbia, SC 29211 Phone: 803-896-4430 Fax: 803-896-9651 www.llr.state.sc.us/pol/environmental/
More informationEXAM APPLICATION FOR REAL ESTATE
South Carolina Department of Labor, Licensing and Regulation South Carolina Real Estate Commission 110 Centerview Dr. Columbia SC 29210 P.O. Box 11847 Columbia SC 29211-1847 Phone: 803-896-4400 Contact.REC@llr.sc.gov
More informationSUBSTITUTE TEACHER APPLICATION
501 Pacific Avenue Bremen, GA 30110 770-537-5508 SUBSTITUTE TEACHER APPLICATION LAST NAME FIRST MIDDLE DATE STREET ADDRESS CITY STATE ZIP TELEPHONE NUMBER EMAIL ADDRESS CURRENT EMPLOYER: HIGHEST EDUCATION
More informationSTUDENT PERMIT APPLICATION INSTRUCTIONS
South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Barber Examiners 110 Centerview Dr. Columbia SC 29210 P.O. Box 11329 Columbia SC 29211-1329 Phone: 803-896-4588 BoardInfo@llr.sc.gov
More informationRE-APPLICATION FOR LPC-SUPERVISOR and LMFT-SUPERVISOR LICENSES [Applicable for lapsed license over two (2) years]
South Carolina Department of Labor, Licensing and Regulation Board of Examiners for Licensure of Professional Counselors, Marriage & Family Therapists And Psycho-Educational Specialists 110 Centerview
More informationAPPLICATION FOR INITIAL LICENSE
South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Examiners in Speech-Language Pathology and Audiology P.O. Box 11329 Columbia, SC 29211 Phone: 803-896-4655 Fax: 803-896-4719
More informationSouth Carolina Department of Labor, Licensing and Regulation South Carolina Real Estate Commission
South Carolina Department of Labor, Licensing and Regulation South Carolina Real Estate Commission 110 Centerview Dr. Columbia SC 29210 P.O. Box 11847 Columbia SC 29211-1847 Phone: 803-896-4400 Contact.REC@llr.sc.gov
More informationGEORGIA BOARD OF PHARMACY A Division of the Georgia Department of Community Health 2 Peachtree Street, N.W. 6 th Floor Atlanta, Georgia 30303
GEORGIA BOARD OF PHARMACY A Division of the Georgia Department of Community Health 2 Peachtree Street, N.W. 6 th Floor Atlanta, Georgia 30303 PHARMACIST APPLICANT INFORMATION SHEET dates are available
More informationDocuments Required With Application. Sky Dancer Casino & Resort
3965 Sky Dancer Way N.E. PO Box 1449 Belcourt ND 58316 www.skydancercasino.com Documents Required With Application Resume should be attached with the following 1. Two forms of Identification 2. High School
More informationPHARMACIST INTERN CERTIFICATE APPLICATION
Include with your application: $50 Check or money order (no cash) payable to LLR-Board Certificate# of Pharmacy. Application fee is non-refundable. A returned check fee of up to $30, or an Check # amount
More informationPetition to Change the Name of an Adult
NOTICE: THIS DOCUMENT CONTAINS SENSITIVE DATA. Cause : (The Clerk s office will fill in the Cause and when you file this form.) Name Change of: Print current full legal name of person asking for name change.
More informationAPPLICATION FOR LICENSURE AS MARRIAGE AND FAMILY THERAPIST SUPERVISOR
SC DEPARTMENT OF LABOR, LICENSING AND REGULATION BOARD OF EXAMINERS FOR THE LICENSURE OF PROFESSIONAL COUNSELORS, MARRIAGE AND FAMILY THERAPISTS, AND PSYCHO-EDUCATIONAL SPECIALISTS Post Office Box 11329
More informationREDMOND MUNICIPAL AIRPORT INITIAL ID APPLICATION AOA ID
REDMOND MUNICIPAL AIRPORT INITIAL ID APPLICATION AOA ID AIRPORT USE - DATE RECEIVED NAME: LAST NAME LEGAL FIRST NAME MIDDLE NAME ALL - NICK NAMES / FORMER NAMES / ALIAS: ID PIN = LAST - 4 OF SSN OR PHONE
More information- Page 1 SAMPLE EXAMINATION TYPE: RECIPROCAL SALESPERSON INSTRUCTIONS
- Page 1 LN, FN MN CITY, XX XXXXX CANDIDATE ID: 000 EXAMINATION DATE: 4/24/2012 INSTRUCTIONS A. Attach an official Certificate of Licensure form (License History NOT A COPY OF YOUR REAL ESTATE LICENSE)
More informationSouth Carolina Department of Labor, Licensing and Regulation South Carolina Board of Registration for Professional Engineers and Surveyors
South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Registration for Professional Engineers and Surveyors (Overnight) 110 Centerview Dr. Columbia SC 29210 (Mailing) P.O.
More informationApplication for Licensure by Comity
South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Registration for Professional Engineers and Surveyors (overnight) 110 Centerview Dr. Columbia SC 29210 (mailing) P.O.
More informationAPPLICATION FOR REINSTATEMENT OF LICENSE. Residence Address Residence City State Zip Code Residence Telephone
SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION Board of Examiners in Speech-Language Pathology and Audiology P O Box 11329 Columbia, SC 29211-1329 Telephone Number (803) 896-4655 Website:
More informationInformation Regarding Dental Licensure by Regional Examination for In State Applicants
BOARD OF DENTAL EXAMINERS OF ALABAMA Stadium Parkway Office Center-Suite 112 5346 Stadium Trace Parkway Hoover, Al 35244-4583 PHONE 205-985-7267 FAX 205-985-0674 e-mail: bdeal@dentalboard.org Information
More informationEmployment Application
Employment Application CorrBox INCORPORATED 24551 Del Prado #639 Dana Point, CA 92629 Tel. (949) 248-5880 Fax. (949) 373-3256 info@corrbox.com Applicant Information Last First M.I. Date: Street Address
More informationCPA LICENSURE APPLICATION BY RECIPROCITY ELECTRONIC APPLICATION FORMS AND INSTRUCTIONS
South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Accountancy 110 Centerview Dr. Columbia SC 29210 P.O. Box 11329 Columbia SC 29211-1329 Phone: 803-896-4770 Contact.Accountancy@llr.sc.gov
More informationGARDENA POLICE DEPARTMENT
For Department Use Only ID#: Employer: Date: ( ) New Hire ( ) Renewal GARDENA POLICE DEPARTMENT GAMING AND CASINO WORK PERMIT APPLICATION GPD/PJR (Revised 03-06) Page 1 of 12 GARDENA POLICE DEPARTMENT
More informationAPPLICATION RESOURCE GUIDE
STATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS 1740 WEST ADAMS STREET, SUITE 3600 PHOENIX, AZ 85007 PHONE: 602.542.1882 FAX: 602.364.0890 Board Website: www.azbbhe.us Email Address: information@azbbhe.us
More informationEmployment Application
Employment Application APPLICANT INFORMATION Last Name First M.I. Date Street Apartment/Unit # City State ZIP E-mail Date Available Social Security No. Desired Salary Position Applied for Are you a citizen
More informationEmployment Eligibility Verification
Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No. 1615-0047 Expires 08/31/2019 START HERE: Read instructions carefully
More informationDriver License Checklist Texas
Driver License Checklist Texas These are the items to take with you to the DPS office when you go to get a Texas Driver License 1. Must have received the state packet back from the state (DL-92). 2. Instruction
More informationAPPLICATION RESOURCE GUIDE
STATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS 1740 WEST ADAMS STREET, SUITE 3600 PHOENIX, AZ 85007 PHONE: 602.542.1882 FAX: 602.364.0890 Board Website: www.azbbhe.us Email Address: information@azbbhe.us
More informationNew Manufactured Contractor/Repairer/ Installer Application
South Carolina Department of Labor, Licensing and Regulation South Carolina Manufactured Housing Board 110 Centerview Dr. Columbia SC 29210 P.O. Box 11329 Columbia SC 29211-1329 Phone: 803-896-4682 contactllr@llr.sc.gov
More informationStudent Employee New-Hire Paperwork
Student Employee New-Hire Paperwork Congrats on landing your first on campus job! In order to be hired and paid on time, you must complete the new hire process by following steps 1-6 outlined below. E-Verify
More informationEmployment Application
Employment Application IMPORTANT Instructions for completing the application form. 1. Type or print clearly in black or blue ink. 2. Answer every question fully and accurately. If not applicable, please
More informationNew Manufactured Retail Dealer Application
South Carolina Department of Labor, Licensing and Regulation South Carolina Manufactured Housing Board 110 Centerview Dr. Columbia SC 29210 P.O. Box 11329 Columbia SC 29211-1329 Phone: 803-896-4682 contactllr@llr.sc.gov
More informationChoctaw Nation Gaming Commission P.O. Box 5229 Durant, OK Phone: (580) Fax: (580)
Choctaw Nation Gaming Commission P.O. Box 5229 Durant, OK 74702-5229 Phone: (580) 924-8112 Fax: (580) 920-4966 Gaming License Application Instructions: 1. Original application must be submitted. A photocopy
More informationSouth Carolina Department of Labor, Licensing and Regulation South Carolina Board of Medical Examiners
110 Centerview Dr Columbia SC 29210 P.O. Box 11289 Columbia SC 29211 REQUIREMENTS AND INSTRUCTIONS FOR A LICENSE TO PRACTICE AS A LIMITED RESPIRATORY CARE PRACTITIONER The Forms contained in this packet
More informationMASSAGE THERAPY ESTABLISHMENT LICENSE APPLICATION BUSINESS INFORMATION. Height Hair Color Eye Color Weight
CITY OF PARK RIDGE 505 BUTLER PLACE PARK RIDGE, IL 60068 TEL: 847/ 318-5291 FAX: 847/ 318-6411 TDD:847/ 318-5252 URL:http://www.parkridge.us DEPARTMENT OF COMMUNITY PRESERVATION AND DEVELOPMENT MASSAGE
More informationOPTOMETRY CREDENTIAL LICENSURE APPLICATION
South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Examiners in Optometry P.O. Box 11329 Columbia, SC 29211 Phone: 803-896-4679 Fax: 803-896-4719 www.llr.state.sc.us/pol/optometry/
More informationLOAN-OUT COMPANY START FORM AND AGREEMENT
150 West 30th Street, Suite 405 New York, NY 10001 (212) 206-1724 tel. (212) 206-1070 fax LOAN-OUT COMPANY START FORM AND AGREEMENT Production Company Loaned Out Employee Name Production Title Name of
More informationEMPLOYEE UPDATE FORM
EMPLOYEE UPDATE FORM Date Submitted: First Name M.I. Last Name Address City State Zip County SSN DOB E-Mail Hire Date: Termination Date: Change Date: Auth. Signature Marital Status: Married Single Gender:
More informationEmployment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No. 1615-0047 Expires 08/31/2019 START HERE: Read instructions carefully
More informationHardee County Board of County Commissioners Equal Employment Opportunity (EEO) Self-Identification Form (completion of this form is voluntary)
Please submit to: Hardee County Board of County Commissioners HR Department 205 Hanchey Road, Wauchula, Florida 33873 Phone: (863) 773-2161 Hardee County Board of County Commissioners Equal Employment
More informationADDICTION COUNSELORS GRANDFATHER LICENSE REQUIREMENTS AND INSTRUCTIONS
South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Examiners for Licensure of Professional Counselors, Marriage and Family Therapists, Addiction Counselors and Psycho-Educational
More informationAPPLICATION FOR SUPPORT PERSONNEL PLEASE READ THIS INSTRUCTION SHEET CAREFULLY
VERNON PARISH SCHOOL SYSTEM 201 BELVIEW ROAD LEESVILLE, LA 71446 337-239-3401 FAX 337-239-7507 APPLICATION FOR SUPPORT PERSONNEL **************************************************************** PLEASE
More informationEmployment Application An Equal Opportunity Employer
Employment Application An Equal Opportunity Employer AllianceHR New Hire Policy: Prior to the employee starting work, the Employee Application and the Employment Eligibility Form (I-9) must be completed
More informationManufactured Retail Dealer Update/New Location/Renewal Application
South Carolina Department of Labor, Licensing and Regulation South Carolina Manufactured Housing Board 110 Centerview Dr. Columbia SC 29210 P.O. Box 11329 Columbia SC 29211-1329 Phone: 803-896-4682 contactllr@llr.sc.gov
More informationApplication Instructions for Licensure as a Speech Language Pathologist or Audiologist
APPLICATION FOR GEORGIA STATE BOARD OF SPEECH LANGUAGE PATHOLOGY/AUDIOLOGY 237 Coliseum Drive, Macon, Georgia 31217 Phone (478) 207-2440 * www.sos.ga.gov/plb/speech Application Instructions for Licensure
More informationCLERK OF THE COURT SUPERIOR COURT OF ARIZONA
CLERK OF THE COURT SUPERIOR COURT OF ARIZONA MOHAVE COUNTY 401 East Spring Street PO Box 7000 Kingman, Arizona 86401 PRIVATE PROCESS SERVER APPLICATION Any willful omission or misrepresentation of any
More informationPHYSICAL THERAPIST (PT) AND PHYSICAL THERAPIST ASSISTANT (PTA) APPLICATION INSTRUCTIONS
PHYSICAL THERAPIST (PT) AND PHYSICAL THERAPIST ASSISTANT (PTA) APPLICATION INSTRUCTIONS ALL APPLICANTS The following is required of ALL applicants for licensure/certification: Application: All applicants
More informationAre you a current WVU student? (Circle One)
\X,est'vlrginialJnivetSil}' Employee Information Form Benefits Eligible: o NO o YES Session:_/_/_@_ AM PM Personal Information (Please Print) Gender: (check one) omale o Female Today's Date: Legal First
More informationAre you a current WVU student? (Circle One)
\X,est'vlrginialJnivetSil}' Employee Information Form Benefits Eligible: o NO o YES Session:_/_/_@_ AM PM Personal Information (Please Print) Gender: (check one) omale o Female Today's Date: First Name
More informationMSU Child Development Laboratories Hiring Packet
MSU Child Development Laboratories Hiring Packet College of Social Science Department of Human Development and Family Studies Child Development Laboratories East Lansing Campus Central School 325 W. Grand
More information... moves to amend H.F. No. 3959, the third engrossment, as follows:
1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8... moves to amend H.F. No. 3959, the third engrossment, as follows: Delete everything after the enacting clause and insert: "Section 1. Minnesota Statutes 2014, section
More informationNOTICE. NEW PROCEDURES FOR OBTAINING AGENCY ISSUED LICENSES/CERTIFICATIONS Effective November 1, 2007
Department of Environmental Quality NOTICE NEW PROCEDURES FOR OBTAINING AGENCY ISSUED LICENSES/CERTIFICATIONS Effective November 1, 2007 In order to comply with Oklahoma s new immigration law, 56 Okla.
More informationHome Model Legislation Public Safety and Elections. Taxpayer and Citizen Protection Act
Search GO LOGIN LOGOUT HOME JOIN ALEC CONTACT ABOUT MEMBERS EVENTS & MEETINGS MODEL LEGISLATION TASK FORCES ALEC INITIATIVES PUBLICATIONS NEWS Model Legislation Home Model Legislation Public Safety and
More informationMelbourne International Airport Police Department Security Badge Application SIDA SECURE Area
Melbourne International Airport Police Department Security Badge Application SIDA SECURE Area Revision : June, 2009 Prior to issuance of an Airport Security Identification Media the U.S. Department of
More informationAre There Cases When You Should Not Use This Form? What Information Is Needed to Search for USCIS Records? Verification of Identity in Person.
Department of Homeland Security U.S. Citizenship and Immigration Services OMB No. 1653-0030; Expires 08/31/05 G-639, Freedom of Information/ Privacy Act Request Instructions NOTE: Please read all Instructions
More informationInstructions For Completing U.S. Citizenship Affidavit For Brain & Spinal Injury Trust Fund Commission (v )
Instructions For Completing U.S. Citizenship Affidavit For Brain & Spinal Injury Trust Fund Commission (v12.17.2014) Dear Applicant: PLEASE REVIEW & TAKE THIS ENTIRE PACKET WITH YOU TO THE NOTARY PUBLIC
More informationCHAPTER 22 - HEARING AID DEALERS AND FITTERS BOARD SUBCHAPTER 22A - BOARD RULES SECTION ORGANIZATIONAL RULES SECTION.
CHAPTER 22 - HEARING AID DEALERS AND FITTERS BOARD SUBCHAPTER 22A - BOARD RULES SECTION.0100 - ORGANIZATIONAL RULES SECTION.0400 DEFINITIONS 21 NCAC 22A.0401 DEFINITIONS AND INTERPRETATIONS (a) The rules
More informationI-9 REFERENCE GUIDE. Student Employment For the employing department: Completing Section 2 December, 2015
I-9 REFERENCE GUIDE Student Employment For the employing department: Completing Section 2 December, 2015 THE FORM I-9 According to Federal Law, all persons working for a new employer are required to show
More informationI-9 REFERENCE GUIDE. Student Employment For the employing department: Completing Section 2 January, 2017
I-9 REFERENCE GUIDE Student Employment For the employing department: Completing Section 2 January, 2017 THE FORM I-9 According to Federal Law, all persons working for a new employer are required to show
More informationNATIONAL PARK SERVICE SEASONAL LAW ENFORCEMENT TRAINING (NPS-SLET) RECRUIT APPLICANT PERSONAL HISTORY STATEMENT
FORM F - 3 (Rev. 02/2012) NATIONAL PARK SERVICE SEASONAL LAW ENFORCEMENT TRAINING (NPS-SLET) RECRUIT APPLICANT PERSONAL HISTORY STATEMENT THIS DOCUMENT MUST BE NOTARIZED PRIOR TO SUBMISSSION READ ALL INSTRUCTIONS/QUESTIONS
More informationMASSAGE/BODYWORK THERAPIST CONTINUING EDUCATION PROVIDER APPLICATION
SC Dept. of Labor, Licensing and Regulation Office of Board Services Massage/Bodywork Therapy 110 Centerview Drive Post Office Box 11329 Columbia, South Carolina 29211-1329 Phone: (803) 896-4588 / Fax:
More informationLast Name First name Middle Initial Address DETACH HERE
Centralized Employee Registry Reporting Form To be completed by the employer within 15 days of hire. Please print or type. EMPLOYER INFORMATION FEIN Required - - FEIN plus last 3-digit suffix used when
More informationINSTRUCTIONS FOR FILLING OUT THE BOISE AIR TERMINAL - APPLICATION FOR NON SIDA AOA ACCESS BADGE. Revised October 19, 2016
AOA INSTRUCTIONS FOR FILLING OUT THE BOISE AIR TERMINAL - APPLICATION FOR NON SIDA AOA ACCESS BADGE Revised October 19, 2016 AOA NOTE: The application must be filled out legibly and completely. If not,
More informationI-9 Reference Guide. Student Employment For the student employee: Completing Section 1 January, 2017
I-9 Reference Guide Student Employment For the student employee: Completing Section 1 January, 2017 The Form I-9 According to Federal Law, all persons working for a new employer are required to show original
More informationNON SIDA VEHICLE ACCESS BADGE/GA
P INSTRUCTIONS FOR FILLING OUT THE BOISE AIR TERMINAL - APPLICATION FOR NON SIDA VEHICLE ACCESS BADGE/GA Revised October 19, 2016 P NOTE: The application must be filled out legibly and completely. If not,
More informationInformation Regarding Dental Licensure by Regional Examination for Out-of-State Applicants
BOARD OF DENTAL EXAMINERS OF ALABAMA Stadium Parkway Office Center-Suite 112 5346 Stadium Trace Parkway Hoover, Al 35244-4583 PHONE 205-985-7267 FAX 205-985-0674 e-mail: bdeal@dentalboard.org Information
More informationState of Maine Office of the Secretary of State
State of Maine Office of the Secretary of State Application for a Notary Public Commission This section is for office use only. Notary Public #: Commission issued: for a Maine Resident Please read these
More informationEMPLOYMENT APPLICATION
CITY OF JONESBORO 124 North Avenue Jonesboro, Georgia 30236 www.jonesboroga.com EMPLOYMENT APPLICATION THE CITY OF JONESBORO ONLY ACCEPTS APPLICATIONS FOR CURRENTLY POSTED POSITIONS. UNSOLICITED APPLICATIONS
More informationAPPLICATION RESOURCE GUIDE
STATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS 1740 WEST ADAMS STREET, SUITE 3600 PHOENIX, AZ 85007 PHONE: 602.542.1882 FAX: 602.364.0890 Board Website: www.azbbhe.us Email Address: information@azbbhe.us
More informationEMPLOYEE PAYROLL ENROLLMENT AND UPDATE FORM
EMPLOYEE PAYROLL ENROLLMENT AND UPDATE FORM Employer Date Submitted: First Name M.I. Last Name Address City State Zip County SSN DOB E-Mail Hire Date: Termination Date: Change Date: Auth. Signature Marital
More information[1] TWO [2] PASSPORT SIZE [2X2] PHOTOGRAPHS OF THE APPLICANT [NO SUBSTITUTES].
Auto Dealer License INFORMATION REQUIRED WITH THE NEW AND USED AUTO DEALER LICENSE APPLICATION [1] TWO [2] PASSPORT SIZE [2X2] PHOTOGRAPHS OF THE APPLICANT [NO SUBSTITUTES]. [2] ORIGINAL VALID DRIVER S
More informationAPPLICATION RESOURCE GUIDE
STATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS 1740 WEST ADAMS STREET, SUITE 3600 PHOENIX, AZ 85007 PHONE: 602.542.1882 FAX: 602.364.0890 Board Website: www.azbbhe.us Email Address: information@azbbhe.us
More informationTHOROUGHBRED RACING AUTHORIZED AGENT LICENSE FORM
THOROUGHBRED RACING AUTHORIZED AGENT LICENSE FORM Name of Applicant: ----------OFFICE USE ONLY---------- Date: License Year: License No.: Cash: / Check No.: Credit Card Amount: Total Fees Received: Reviewer:
More informationInstructions for Remote Workers on Completing the Form I-9 Employment Verification
Instructions for Remote Workers on Completing the Form I-9 Employment Verification Federal Law requires that Carnegie Mellon University must have a valid Form I-9 on file for every employee. Federal Law
More informationInstructions for Applying to be Reinstated After 5 Years
Instructions for Applying to be Reinstated After 5 Years If you have been inactive for more than five consecutive years as a real estate salesperson or broker you must complete this application. If your
More informationInternational Student Employment Packet
International Student Employment Packet Most commonly provided items to bring to the Financial Aid Office: I-94 I-20 or DS-2019 Unexpired Foreign Passport Receipt of application for Social Security Card
More informationfor fingerprint submitting agencies and contractors Prepared by the National Crime Prevention and Privacy Compact Council
for fingerprint submitting agencies and contractors Prepared by the National Crime Prevention and Privacy Compact Council The National Crime Prevention and Privacy Compact Council (Compact Council) is
More informationCITY OF SHERIDAN, WYOMING
CITY OF SHERIDAN, WYOMING Office Use Only Received: HUMAN RESOURCES DEPARTMENT Phone: (307) 674-6483 (Please Use for mailing) Fax: (307) 675-4270 55 Grinnell Plaza, P.O. Box 848 Email: hdoke@sheridanwy.net
More informationTo schedule an Application Processing Appointment
REDMOND MUNICIPAL AIRPORT (RDM) Secured & Sterile Area ID Application THIS PAGE FOR APPLICANT TO KEEP Identification badges issued by Redmond Municipal Airport (RDM) are, and remain, property of the Airport.
More informationWhat Is the Purpose of This Form? Who May File This Application? What Are the General Filing Instructions?
Department of Homeland Security OMB No. 1615-0082; Expires 04/30/06 I-90, Application to Replace Permanent Resident Card Instructions NOTE: You may file Form I-90 electronically. Go to our internet website
More informationID ACCESS BADGE APPLICATION FOR AOA and NON-SIDA
ID ACCESS BADGE APPLICATION FOR AOA and NON-SIDA 3880 NE 39 th Avenue, Suite A Airport Operations Dept. Gainesville, Fl 32609 Phone: 352-373-0249 Fax: 352-374-8368 AIRPORT OFFICE USE ONLY BADGE TYPE BADGE
More informationAPPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE
APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE MATERIALS TO BE SUBMITTED (Retain this Sheet for Your Records) The Board prefers that the materials listed below be submitted with your application;
More informationInstructions Read all instructions carefully before completing this form.
Department of Homeland Security U.S. Citizenship and Immigration Services OMB No. 1615-0047;; Expires 08/31/12 Form I-9, Employment Eligibility Verification Instructions Read all instructions carefully
More informationNEW HIRE / REPLACEMENT INFORMATION
NEW HIRE / REPLACEMENT INFORMATION NAME: ADDRESS: CITY, STATE, & ZIP: SOCIAL SECURITY #: DATE OF BIRTH: LOCAL NUMBER FILING STATUS: SINGLE OR MARRIED - PLEASE CIRCLE ONE NUMBER OF DEPENDENTS: CLASS: (1
More informationCherokee County Fire & Emergency Services
Cherokee County Fire & Emergency Services Application for the Position of: VOLUNTEER SERVICE REV.9/2010 CHEROKEE COUNTY FIRE & EMERGENCY SERVICES 150 Chattin Drive, Canton, GA 30115 678-493-4000 (phone)
More informationAPPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE
APPLICATION FOR DENTAL HYGIENE/ PROVISIONAL LICENSURE MATERIALS TO BE SUBMITTED (Retain this Sheet for Your Records) The Board prefers that the materials listed below be submitted with your application;
More informationNotice of Rulemaking Hearing
For Department of State Use Only Department of State Division of Publications Sequence Number: 312 Rosa L. Parks Ave., 8th Floor, Snodgrass/TN Tower Nashville, TN 37243 Phone: 615-741-2650 Email: publications.information@tn.gov
More informationMunicipality of PENN HILLS
Municipality of PENN HILLS 12245 Frankstown Road Pittsburgh, PA 15235 PHONE: 412.798.2100 FAX: 412.798.2109 APPLICATION FOR EMPLOYMENT POSITION DESIRED: DATE: NAME: / / (Last) (First) (M.I) ADDRESS: (Number
More informationHARNESS RACING OWNER / TRAINER / DRIVER LICENSE FORM
HARNESS RACING OWNER / TRAINER / DRIVER LICENSE FORM ----------OFFICE USE ONLY---------- Date: License Year: License No.: Cash: / Check No.: Credit Card Amount: Total Fees Received: Reviewer : New Renewal
More informationGENERAL AVIATION APPLICATION
GENERAL AVIATION APPLICATION INSTRUCTION SHEET FOR COMPLETING THE BOISE AIRPORT GA APPLICATION (Revised October 2017) The application must be filled out legibly and completely. If not, the application
More informationSTATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS
STATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS The initial detective application must be completed in its entirety. An incomplete application will
More informationESPERANZA HEALTH SYSTEMS, LTD. D/B/A LA HACIENDA TREATMENT CENTER ARBITRATION AGREEMENT
ESPERANZA HEALTH SYSTEMS, LTD. D/B/A LA HACIENDA TREATMENT CENTER ARBITRATION AGREEMENT PLEASE READ AND SIGN THIS PAGE BEFORE COMPLETING THE APPLICATION PACKET Esperanza Health Systems, Ltd. D/B/A/ La
More informationAPPLICATION FOR LMSW LICENSURE
APPLICATION FOR LMSW LICENSURE Please type or print all information. Incomplete applications will be returned. When space provided is insufficient, attach additional sheets, with your name and Social Security
More informationPlease mail your completed application, documentation and required fee(s) to: 2601 Blair Stone Road Tallahassee, Fl
State of Florida Board of Auctioneers Application for Initial Licensure as Auctioneer Form # DBPR AU-4153 1 of 9 APPLICATION CHECKLIST IMPORTANT Submit items on the checklist below with your application
More informationREQUEST FOR TECHNICAL CHANGE
REQUEST FOR TECHNICAL CHANGE AGENCY: Hearing Aid Dealers and Fitters Board RULE CITATION: All Rules DEADLINE FOR RECEIPT: Friday, February, 01 PLEASE NOTE: This request may extend to several pages. Please
More informationTHOROUGHBRED RACING OWNER / TRAINER LICENSE FORM
THOROUGHBRED RACING OWNER / TRAINER LICENSE FORM NAME OF APPLICANT: ----------OFFICE USE ONLY---------- Date: License Year: License No.: Check No.: Credit Card Amount: Total Fees Received: Reviewer: New
More information