CALIPATRIA UNIFIED SCHOOL DISTRICT 501 WEST MAIN STREET, CALIPATRIA, CA Application for Coaching
|
|
- Arleen Neal
- 5 years ago
- Views:
Transcription
1 CALIPATRIA UNIFIED SCHOOL DISTRICT 501 WEST MAIN STREET, CALIPATRIA, CA Application for Coaching Last Name First Name Middle Other Legal Name Used Address (Mailing and Physical if different) City, State, Zip Code Telephone Telephone Soc Sec No. Position(s) for which you are applying Do you have a valid California Driver's License? Have you previously worked for Calipatria Unified School District? Date Available for Employment School Site: Class/Type: If yes, please state when: Education and/or Experience History Please attach any qualifying certificates or transcripts and include a resume describing education, training or participation experience as needed. Dates Example: Name & Address of agency where education or experience Calipatria High School, Calipatria, California Describe education, training of participation Played football/basketball/baseball Personal References Name Address Telephone How long known I HEREBY CERTIFY that all statements made herein are true and correct to the best of my knowledge and AUTHORIZE investigation of all statements contained herein. I UNDERSTAND if I am hired, I will be required to submit verification of my legal right to work in the United States and submit to fingerprinting for criminal background Signature of Applicant Date
2 Calipatria Unified School District Certification for Temporary Athletic Coaches Qualifications For School Year Name: Address: Telephone Number(s): REQUIRED QUALIFICATIONS 1. Criminal Background Check No Conviction of Offenses Involving Moral Turpitude or Unfitness to Associate with Children (EC 44010, 44011, 44424, Serious Felony, Sex Offenses or Controlled Substance Offenses) All paid and volunteer coaches must have clearance through DOJ and FBI. Please check status of each applicant prior to starting assignment. 2. Examination for tuberculosis (Education Code 49406) All paid coaches must have tuberculosis assessment upon hire and every four (4) years thereafter. COMPETENCY REQUIREMENTS (5 CCR 5593): Information must be provided for at least one item in each box in Sections 3 through 6 below. Attached additional documentation as needed. 3. Care and Prevention of Athletic Injuries, Basic First Aid and Emergency Procedures A. Completion of a college level course in the care and prevention of athletic injuries and possession of a valid CPR card Course Name: Institution: Verification (Name Title Date) B. Valid sports injury certificate or first aid card and CPR card Sports Injury Certificate Exp. First Aid Card Exp. CPR Card Exp. 4. Coaching Techniques: Coaching Theory and Techniques in the Sport or Game Being Coached C. Valid Emergency Technician (EMT) I or II card D. Valid National or California Athletic Trainer s Assoc. Trainer s certificate E. Experience supervised by a qualified athletic trainer with valid CPR and First Aid cards. A. Completion of a college course in coaching theory and techniques B. Completion of District or County Office Inservice Program C. Prior Service as a Student Coach or Asst. Athletic Coach in the sport being coached D. Prior coaching in community youth athletic programs in the sport being coached EMP I or II Card Exp. ATC Certificate # Exp. Date Verification attached including name of trainer, dates of supervised experience and name of qualified trainer. Course Name: Institution: Inservice by: Name of Program: Sport(s): Name of Program: Sport(s):
3 Calipatria Unified School District Certification for Temporary Athletic Coaches Qualifications For School Year Name: Address: Telephone Number(s): REQUIRED QUALIFICATIONS 4. Coaching Techniques (continued) E. Prior participation in organized competitive athletics at high school level or above in sport being coached 5. Rules & Regulations Pertaining to the Sport or Game Being Coached, league rules, including Calif. Interscholastic Federation (CIF) regulations at the high school level Name of Sport(s): Course(s), Seminar(s): Prior Experience: Date(s) Name of Program: Sport(s): Other Evidence: 6. Child or Adolescent Psychology, whichever appropriate to grade level of the activity involved A. Completion of College Level Course in Child Psychology (Elementary School) or Adolescent or Sports Psychology (High School) B. Completion of Seminar or Workshop on Human Growth and Development of Youth C. Prior Active Involvement with Youth in School/Community Sports Program Course Title: Name of Institution: Course Title: Name of Institution: Sports Program: Period of Time/Dates: Waiver of Competency Requirements allowed if enrolled in appropriate training courses leading to acquisition of competency. 7. Competency Compliance Waiver Course Name(s) Anticipated Date(s) of Completion: Name of Supervising Coach:
4 Calipatria Unified School District Certification for Temporary Athletic Coaches Qualifications For School Year Name: Address: Telephone Number(s): REQUIRED QUALIFICATIONS 8. CODE OF ETHICAL CONDUCT Employees providing supervisory or instructional services in interscholastic athletic programs and activities shall: (5 CCR 5596) (a) Show respect for players, officials and other coaches. (b) Respect the integrity and judgment of game officials. (c) Establish and model fair play, sportsmanship, and proper conduct. (d) Establish player safety and welfare as the highest priority. (e) Provide proper supervision of students at all times. (f) Use discretion when providing constructive criticism and when reprimanding players. (g) Maintain consistency in requiring all players to adhere to the established rules and standards of the game to be played. (h) Properly instruct players in the safe use of equipment. (i) Avoid exerting undue influence on a pupil's decision to enroll in an athletic program at any public or private postsecondary educational institution. (j) Avoid exerting undue influence on pupils to take lighter academic course(s) in order to be eligible to participate in athletics. (k) Avoid suggesting, providing, or encouraging any athlete to use nonprescription drugs, anabolic steroids, or any substance to increase physical development or performance that is not approved by the United States Food and Drug Administration, Surgeon General of the United States or American Medical Association. (l) Avoid recruitment of athletes from other schools. (m) Follow the rules of behavior and the procedures for crowd control as established by the local board of education and the league in which the district participates. CERTIFICATION I hereby certify that the provisions of Education Code and California Code of Regulations Title have been met. I also agree to abide by the Code of Ethical Conduct as required by California Code of Regulations Title Signature Temporary Athletic Coach Date Signature Superintendent s Designee (Principal or Athletic Director) Date
5 Please keep this information for your reference No Conviction of Offenses Involving Moral Turpitude or Unfitness to Associate with Children (EC 44010, 44011, 44424, Serious Felony, Sex Offenses, Controlled Substance Offense) Education Code Sex Offense; School Employees "Sex offense," as used in Sections 44020, 44237, 44346, 44425, 44436, 44836, and 45123, means any one or more of the offenses listed below: (a) Any offense defined in Section 220, 261, 261.5, 262, 264.1, 266, 266j, 267, 285, 286, 288, 288a, 288.5, 289, 311.1, 311.2, 311.3, 311.4, , , 313.1, 647b, 647.6, or former Section 647a, subdivision (a), (b), (c), or (d) of Section 243.4, or subdivision (a) or (d) of Section 647 of the Penal Code. (b) Any offense defined in former subdivision (5) of former Section 647 of the Penal Code repealed by Chapter 560 of the Statutes of 1961, or any offense defined in former subdivision (2) of former Section 311 of the Penal Code repealed by Chapter 2147 of the Statutes of 1961, if the offense defined in those sections was committed prior to September 15, 1961, to the same extent that an offense committed prior to that date was a sex offense for the purposes of this section prior to September 15, (c) Any offense defined in Section 314 of the Penal Code committed on or after September 15, (d) Any offense defined in former subdivision (1) of former Section 311 of the Penal Code repealed by Chapter 2147 of the Statutes of 1961 committed on or after September 7, 1955, and prior to September 15, (e) Any offense involving lewd and lascivious conduct under Section 272 of the Penal Code committed on or after September 15, (f) Any offense involving lewd and lascivious conduct under former Section 702 of the Welfare and Institutions Code repealed by Chapter 1616 of the Statutes of 1961, if that offense was committed prior to September 15, 1961, to the same extent that an offense committed prior to that date was a sex offense for the purposes of this section prior to September 15, (g) Any offense defined in Section 286 or 288a of the Penal Code prior to the effective date of the amendment of either section enacted at the Regular Session of the Legislature committed prior to the effective date of the amendment. (h) Any attempt to commit any of the offenses specified in this section. (i) Any offense committed or attempted in any other state or against the laws of the United States which, if committed or attempted in this state, would have been punishable as one or more of the offenses specified in this section. (j) Any conviction for an offense resulting in the requirement to register as a sex offender pursuant to Section 290 of the Penal Code. (k) Commitment as a mentally disordered sex offender under former Article 1 (commencing with Section 6300) of Chapter 2 of Part 2 of the Welfare and Institutions Code, as repealed by Chapter 928 of the Statutes of Education Code Controlled Substance Offense "Controlled substance offense" as used in Sections 44346, 44425, 44436, 44836, and means any one or more of the following offenses: (a) Any offense in Sections to 11355, inclusive, 11361,11366, 11368,11377 to 11382, inclusive, and of the Health and Safety Code. (b) Any offense committed or attempted in any other state or against the laws. of the United States which, if committed or attempted in this state, would have been punished as one or more of the above-mentioned offenses. (c) Any offense committed under former Sections to 11503, inclusive, 11557, 11715, and of the Health and Safety Code. (d) Any attempt to commit any of the above-mentioned offenses. Education Code Conviction Of Certain Penal Code Sections Ground For Revocation (a) Upon the conviction of the holder of any credential issued by the State Board of Education or the Commission on Teacher Credentialing of a violation, or attempted violation, of a violent or serious felony as described in Section , or any one or more of Penal Code Sections 187 to 191, inclusive, 192 insofar as this section relates to voluntary manslaughter, 193, 194 to 217.1, inclusive, 220, 222, 244, 245, 261 to 267, inclusive, 273a, 273ab, 273d, 273f, 273g, 278, 285 to 288a, inclusive, 424, 425, 484 to 488, inclusive, insofar as these sections relate to felony convictions, 503 and 504, or of any offense involving lewd and lascivious conduct under Section 272 of the Penal Code, or any offense committed or attempted in any other state or against the laws of the United States which, if committed or attempted in this state, would have been punished as one or more of the offenses specified in this section, becoming final, the commission shall forthwith revoke the credential.
6 (b) Upon a plea of nolo contendere as a misdemeanor to one or more of the crimes set forth in subdivision (a), all credentials held by the respondent shall be suspended until a final disposition regarding those credentials is made by the commission. Any action that the commission is permitted to take following a conviction may be taken after the time for appeal has elapsed, or the judgment of conviction has been affirmed on appeal, or when an order granting probation is made suspending the imposition of sentence and the time for appeal has elapsed or the judgment of conviction has been affirmed on appeal, irrespective of a subsequent order under the provisions of Section of the Penal Code. (c) The commission shall revoke a credential issued to a person whose employment has been denied or terminated pursuant to Section (d) Notwithstanding subdivision (a), a credential shall not be revoked solely on the basis that the applicant or holder has been convicted of a violent or serious felony if the person has obtained a certificate of rehabilitation and pardon pursuant to Chapter 3.5 (commencing with Section ) of Title 6 of Part 3 of the Penal Code. Education Code Mandatory Leave of Absence Offense (a) For purposes of this section, "charged with a mandatory leave of absence offense" is defined to mean charged by complaint, information, or indictment filed in a court of competent jurisdiction with the commission of any sex offense as defined in Section 44010, or with the commission of any offense involving aiding or abetting the unlawful sale, use, or exchange to minors of controlled substances listed in Schedule I, II, or III, as contained in Section 11054, 11055, and of the Health and Safety Code, with the exception of marijuana, mescaline, peyote, or tetrahydrocannabinols. (b) For purposes of this section, "charged with an optional leave of absence offense" is defined to mean a charge by complaint, information, or indictment filed in a court of competent jurisdiction with the commission of any controlled substance offense as defined in Section or 87011, or a violation or attempted violation of Section 187 of the Penal Code, or Sections to 11361, inclusive, Section 11363, 11364, or of the Health and Safety Code, insofar as these sections relate to any controlled substances except marijuana, mescaline, peyote, or tetrahydrocannabinols. (c) For purposes of this section and Section , the term "school district" includes county offices of education. (d) (1) Whenever any certificated employee of a school district is charged with a mandatory leave of absence offense, as defined in subdivision (a), upon being informed that a charge has been filed, the governing board of the school district shall immediately place the employee on compulsory leave of absence. The duration of the leave of absence shall be until a time not more than 10 days after the date of entry of the judgment in the proceedings. No later than 10 days after receipt of the complaint, information, or indictment described by subdivision (a), the school district shall forward a copy to the Commission on Teacher Credentialing. (2) Upon receiving a copy of a complaint, information, or indictment described in subdivision (a) and forwarded by a school district, the Commission on Teacher Credentialing shall automatically suspend the employee's teaching or service credential. The duration of the suspension shall be until a time not more than 10 days after the date of entry of the judgment in the proceedings. (e) (1) Whenever any certificated employee of a school district is charged with an optional leave of absence offense as defined in subdivision (b), the governing board of the school district may immediately place the employee upon compulsory leave in accordance with the procedure in this section and Section If any certificated employee is charged with an offense deemed to fall into both the mandatory and the optional leave of absence categories, as defined in subdivisions (a) and (b), that offense shall be treated as a mandatory leave of absence offense for purposes of this section. No later than 10 days after receipt of the complaint, information, or indictment described by subdivision (a), the school district shall forward a copy to the Commission on Teacher Credentialing. (2) Upon receiving a copy of a complaint, information, or indictment described in subdivision (a) and forwarded by a school district, the Commission on Teacher Credentialing shall automatically suspend the employee's teaching or service credential. The duration of the suspension shall be until a time not more than 10 days after the date of entry of the judgment in the proceedings.
DISMISSAL/SUSPENSION/DISCIPLINARY ACTION AR 4118
Causes for Suspension or Dismissal A certificated employee with permanent status may be suspended without pay or dismissed only for one or more of the following causes: (Education Code 44932) 1. Immoral
More informationApplication for Employment
570 Piedmont Road Marietta, GA 30066 Phone: (678) 709-6634 Application for Employment POSITION(S) DESIRED NAME LAST FIRST MIDDLE SOCIAL SECURITY NUMBER 1 Present Address STREET (AREA CODE) TELEPHONE CITY
More informationSTANDARD NON-CERTIFIED APPLICATION For Non-Certified Positions at Belle Valley Public School District #119
STANDARD NON-CERTIFIED APPLICATION For n-certified Positions at Belle Valley Public School District #119 (PLEASE PRINT OR TYPE) POSITION(S) DESIRED NAME LAST FIRST MIDDLE SOCIAL SECURITY NUMBER PRESENT
More informationOROVILLE UNION HIGH SCHOOL DISTRICT. BP 4118 (a) Personnel. Dismissal/Suspension/Disciplinary Action
BP 4118 (a) Dismissal/Suspension/Disciplinary Action The Governing Board expects all employees to perform their jobs satisfactorily, exhibit professional and appropriate conduct, and serve as positive
More informationENROLLED HOUSE BILL No. 4928
Act No. 130 Public Acts of 2005 Approved by the Governor September 28, 2005 Filed with the Secretary of State September 29, 2005 EFFECTIVE DATE: January 1, 2006 STATE OF MICHIGAN 93RD LEGISLATURE REGULAR
More information(cf Concepts and Roles) (cf / Criminal Record (cf / / Professional Standards)
BP 4118(a) Personnel The Governing Board expects all employees to perform their jobs satisfactorily, exhibit professional and appropriate conduct and serve as positive role models at school and in the
More informationEMPLOYMENT APPLICATION
817 Carpenter Street, Bridgeview Complex Camden, NJ 08102 Ph: (856) 963-2627 Fax: (856) 963-2628 Email: info@ecocharterschool.org EMPLOYMENT APPLICATION Name _ Last First Middle Home Present Address Permanent
More informationSAN FRANCISCO EMERGENCY MEDICAL SERVICES AGENCY CERTIFICATE/LICENSE DISCIPLINE PROCESS FOR PREHOSPITAL PERSONNEL
SAN FRANCISCO EMERGENCY MEDICAL SERVICES AGENCY I. PURPOSE CERTIFICATE/LICENSE DISCIPLINE PROCESS FOR PREHOSPITAL PERSONNEL Policy Reference No.: 2070 Review Date: January 1, 2013 Supersedes: September
More informationALABAMA PEACE OFFICERS STANDARDS AND TRAINING COMMISSION ADMINISTRATIVE CODE
Peace Officers Chapter 650-X-2 ALABAMA PEACE OFFICERS STANDARDS AND TRAINING COMMISSION ADMINISTRATIVE CODE CHAPTER 650-X-2 REQUIRED STANDARDS FOR APPOINTEES AS LAW ENFORCEMENT OFFICERS AND FOR APPLICANTS
More informationMANHATTAN SCHOOL DISTRICT NO. 3 Application for Classified / Coaching / Activities / Substitute Teaching Employment
District Use Only Date Completed Application Received: SS Card Driver s license TB Test W-4 I-9 Other Background Check: Form received Date requested Date received Hiring personnel review record. Please
More informationAcademy District 20 Non-Parent Volunteer Application Form. Process Information for Principals
Process Information for Principals Selection of and number of volunteers is at the discretion of the principal. Definition of a Non-Parent Volunteer: An individual over the age of 18 who does not have
More informationLos Alamitos Unified School District Bloomfield Street Los Alamitos, California x80406
Los Alamitos Unified School District 10293 Bloomfield Street Los Alamitos, California 90720 562-799-4700 x80406 Dear Applicant: The application process for administrative positions with the Los Alamitos
More informationFILED STATE OF CALIFORNIA MEDICAL BOARD OF CALIFORNIA SACRAMENTO L)l") 1.., !..]_ BY 'i\ < 1 c l-y..._,,.:l') ANALYST
2 3 4 5 6 7 KATHLEEN A. KENEALY Acting Attorney General of California JUDITH T. ALVARADO Supervising Deputy Attorney General CHRISTINA L. SEIN Deputy Attorney General State Bar No. 229094 California Department
More informationPROFESSIONAL APPLICATION Main and Mitchell Road P. O. Box 288 Booker, TX Ph: (806)
BOOKER INDEPENDENT SCHOOL DISTRICT PROFESSIONAL APPLICATION Main and Mitchell Road P. O. Box 288 Booker, TX 79005 Ph: (806) 658-4501 We consider applicants for all positions without regard to race, color,
More informationFort Worth ISD EMPLOYMENT REQUIREMENTS AND RESTRICTIONS CRIMINAL HISTORY AND CREDIT REPORTS
DEFINITIONS CRIMINAL HISTORY RECORD CRIMINAL HISTORY RECORD INVESTIGATIONS Convicted or conviction shall be construed to mean a conviction by a verdict, by a plea of guilt, or by a judgment of a court
More informationCHILDREN, YOUTH AND FAMILIES GENERAL PROVISIONS GOVERNING BACKGROUND CHECKS AND EMPLOYMENT HISTORY VERIFICATION
TITLE 8 CHAPTER 8 PART 3 SOCIAL SERVICES CHILDREN, YOUTH AND FAMILIES GENERAL PROVISIONS GOVERNING BACKGROUND CHECKS AND EMPLOYMENT HISTORY VERIFICATION 8.8.3.1 ISSUING AGENCY: Children, Youth and Families
More informationName Social Security No. Mailing Address Physical Address. City State Zip Phone ( ) Work Phone ( ) . First Choice Second Choice
Heber-Overgaard Unified School District #6 P.O. Box 547; 3375 Buckskin Canyon Heber, Arizona 85928 Telephone (928) 535-4622 Fax (928) 535-5146 Email: HR@h-oschools.org www.heberovergaardschools.org APPLICATION
More informationLADERA RECREATION DISTRICT 150 Andeta Way, Portola Valley, CA (650) APPLICATION FOR EMPLOYMENT
LADERA RECREATION DISTRICT 150 Andeta Way, Portola Valley, CA 94028 (650) 854-3242 manager@laderarec.org APPLICATION FOR EMPLOYMENT POSITION(S) APPLYING FOR NAME Last First Middle ADDRESS Street City Zip
More informationIDAHO SEX-OFFENDER REGISTRATION AND NOTIFICATION
IDAHO SEX-OFFENDER REGISTRATION AND NOTIFICATION CONTACT INFORMATION Idaho State Police Central Sex-Offender Registry PO Box 700 Meridian, ID 83680-0700 Telephone: 208-884-7305 E-mail: idsor@isp.state.id.us
More informationVolunteer/Staff Screening Policy in Missouri Board Approved August 6, 2005 Board Revised April 15, 2011
Volunteer/Staff Screening Policy in Missouri Board Approved August 6, 2005 Board Revised April 15, 2011 I. SCREENING INTRODUCTION Special Olympics has the right and responsibility to take all reasonable
More informationROUGH ROCK COMMUNITY SCHOOL, INC. HC 61 Box 5050 PTT Rough Rock, Arizona Phone: (928)
ROUGH ROCK COMMUNITY SCHOOL, INC. HC 61 Box 5050 PTT Rough Rock, Arizona 86503 Phone: (928) 728 3700 CLASSIFIED EMPLOYMENT APPLICATION Date: Please complete entire application in full. Do not use refer
More informationYORKTOWN COMMUNITY SCHOOLS Administration Office 2311 S. Broadway St. Yorktown, IN Phone: (765)
YORKTOWN COMMUNITY SCHOOLS Administration Office 2311 S. Broadway St. Yorktown, IN 47396 Phone: (765) 759-2720 NON-CERTIFIED APPLICATION INSTRUCTIONS: Please type or print legibly in black ink. All areas
More informationPRE-EMPLOYMENT APPLICATION PACKET PAVEMENT SOLUTIONS, LLC
PRE-EMPLOYMENT APPLICATION PACKET PAVEMENT SOLUTIONS, LLC COMPANY NAME STREET ADDRESS APPLICATION FOR EMPLOYMENT Pavement Solutions #20 MID RIVERS TRADE COURT CITY, STATE, ZIP CODE ST. PETERS, MO 63376
More informationCONTINUING CERTIFICATE REINSTATEMENT REQUIREMENTS
CONTINUING CERTIFICATE REINSTATEMENT REQUIREMENTS This application is for reinstatement of an expired continuing certificate. Individuals who hold a valid continuing certificate should visit our Web site
More informationInstructions: download in Adobe Reader, complete, save and to NAME Last First Middle Social Security Number
Teacher Application 250 West King St., York, PA 17401 717-848-9835 www.logosyork.org Instructions: download in Adobe Reader, complete, save and email to kim.eberly@logosyork.org. DATE NAME Last First Middle
More informationEMERGENCY SUBSTITUTE CERTIFICATION REQUIREMENTS EMERGENCY SUBSTITUTE CERTIFICATION CHECKLIST
EMERGENCY SUBSTITUTE CERTIFICATION REQUIREMENTS School districts, private schools or educational service districts that have exhausted or reasonably anticipates they will exhaust their list of qualified
More informationAN ACT. Be it enacted by the General Assembly of the State of Ohio:
(131st General Assembly) (Amended Substitute Senate Bill Number 97) AN ACT To amend sections 2152.17, 2901.08, 2923.14, 2929.13, 2929.14, 2929.20, 2929.201, 2941.141, 2941.144, 2941.145, 2941.146, and
More informationSession Law Creating the Minnesota Sentencing Guidelines Commission and Abolishing Parole, 1978 Minn. Laws ch. 723
Session Law Creating the Minnesota Sentencing Guidelines Commission and Abolishing Parole, 1978 Minn. Laws ch. 723 DISCLAIMER: This document is a Robina Institute transcription of statutory contents. It
More informationUNIVERSITY OF CALIFORNIA SAN FRANCISCO Resume Supplement/Conviction History Form. Name: Last First M.I.
UNIVERSITY OF CALIFORNIA SAN FRANCISCO Resume Supplement/Conviction History Form Certain information on this form is required by law. Final candidates must complete this form prior to date of hire. A copy
More informationSALESPERSON INITIAL LICENSE APPLICATION INSTRUCTIONS AND REQUIREMENTS
STATE BOARD OF VEHICLE MANUFACTURERS, DEALERS & SALESPERSONS PO Box 2649 Harrisburg PA 17105-2649 Phone Number: 717-783-1697 Fax Number: 717-787-0250 www.dos.pa.gov/vehicle SALESPERSON INITIAL LICENSE
More informationMERCER COUNTY CAREER CENTER 776 Greenville Road Mercer, Pennsylvania
APPLICATION for EMPLOYMENT MERCER COUNTY CAREER CENTER 776 Greenville Road Mercer, Pennsylvania 16137 724-662-3000 Date (Please type or print) POSITION(S) DESIRED Name _ Last First Middle Present Address
More informationGeneral Plumbing Supply Co., Inc. P.O. Box San Luis Road Walnut Creek, CA 94597
General Plumbing Supply Co., Inc. P.O. Box 4666 1530 San Luis Road Walnut Creek, CA 94597 An Equal Opportunity Employer PLEASE PRINT Date: Name: Last Middle First Business Telephone: ( ) Home Telephone:
More informationFILED STATE OF CALIFORNIA MEDICAL BOARD OF CALIFORNIA SACRAMENTO Dec, I~ BYt:an\ra~ on ANALYST
1 2 3 4 5 6 7 XAVIER BECERRA Attorney General of California MATTHEW M. DA VIS Supervising Deputy Attorney General JASON J. AHN. Deputy Attorney General State Bar No. 253172 600 WestBroadway, Suite 1800
More informationNEW YORK. New York Correction Law Article Discretionary Relief From Forfeitures and Disabilities Automatically Imposed By Law
NEW YORK New York Correction Law Article 23 -- Discretionary Relief From Forfeitures and Disabilities Automatically Imposed By Law Section 700. Definitions and rules of construction. 701. Certificate of
More informationALABAMA PRIVATE INVESTIGATION BOARD ADMINISTRATIVE CODE CHAPTER 741-X-6 DISCIPLINARY ACTION TABLE OF CONTENTS
ALABAMA PRIVATE INVESTIGATION BOARD ADMINISTRATIVE CODE CHAPTER 741-X-6 DISCIPLINARY ACTION TABLE OF CONTENTS 741-X-6-.01 741-X-6-.02 741-X-6-.03 741-X-6-.04 741-X-6-.05 741-X-6-.06 741-X-6-.07 741-X-6-.08
More informationSocial Security Number Required: Enter on separate page provided in the application. 7 Dentist Address:
FLORIDA BOARD OF DENTISTRY DENTAL RADIOGRAPHY CERTIFICATION APPLICATION Chapter 466.004 and 466.017(5), Florida Statutes Rule 64B5-9.011, Florida Administrative Code SPECIAL TES AND INSTRUCTIONS: 1. A
More informationCertificates of Rehabilitation in Fresno County Filing Instructions
Certificates of Rehabilitation in Fresno County Filing Instructions 1. You must be a resident of Fresno County to file a certificate of rehabilitation in Fresno County. However, the offense may have occurred
More informationOglala Sioux Tribe Department of Public Safety PO Box 300 Pine Ridge, South Dakota Phone (605) Fax (605)
Oglala Sioux Tribe Department of Public Safety PO Box 300 Pine Ridge, South Dakota 57770 Phone (605) 867-5141 Fax (605) 867-5953 Required Documents for this OST DPS Application ADMINISTRATIVE & TELECOMMUNICATIONS
More informationARKANSAS STATE POLICE PRIVATE BUSINESS RECOGNITION APPLICATION
ARKANSAS STATE POLICE PRIVATE BUSINESS RECOGNITION APPLICATION FOR OFFICE USE ONLY EFFECTIVE 1-7-2019 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public record
More informationHumane Society Police Officers 22 Pa.C.S.A. Chapter 37
Humane Society Police Officers 22 Pa.C.S.A. Chapter 37 (Last updated June 9, 2005) The following is an "unofficial" copy of the 22 Pa.C.S.A. Chapter 37, entitled Humane Society Police Officers. Senate
More informationAPPLICATION FOR CERTIFICATED SUBSTITUTE EMPLOYMENT
APPLICATION FOR CERTIFICATED SUBSTITUTE EMPLOYMENT Date: 1. Name: Last First Middle Current Address: Home Telephone: ( ) - Cell Phone: ( ) - E-Mail: Social Security No.: - - Former Name(s) by which records
More informationEhrenclou & Grover. attorneys at law
Ehrenclou & Grover attorneys at law DUI LAW There are many relevant statutes with respect to driving under the influence of alcohol or drugs charges. O.C.G.A. 40-6-391 Drivers with ability impaired by
More informationFederal Criminal Background Check
Federal Criminal Background Check The College of Education at Montana State University Billings (MSUB) requires that a national criminal history background check, including fingerprinting, to be completed
More informationEMPLOYEE REGISTRATION INFORMATION
EMPLOYEE REGISTRATION INFORMATION This application must be filed by the licensee (employer) for every employee who will be employed by the licensee (employer) as a private investigator or armed security
More informationCRIMES CODE (18 PA.C.S.) AND JUDICIAL CODE (42 PA.C.S.) - OMNIBUS AMENDMENTS Act of Jul. 5, 2012, P.L. 880, No. 91 Cl. 18 Session of 2012 No.
HB 75 CRIMES CODE (18 PA.C.S.) AND JUDICIAL CODE (42 PA.C.S.) - OMNIBUS AMENDMENTS Act of Jul. 5, 2012, P.L. 880, No. 91 Cl. 18 Session of 2012 No. 2012-91 AN ACT Amending Titles 18 (Crimes and Offenses)
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 informationBullhead City Police Department Explorer Application Instructions
Bullhead City Police Department Explorer Application Instructions This application will be used to determine your eligibility for acceptance to the Bullhead City Police Department Explorer. Please follow
More informationIf you are applying for a government-issued license, certificate, or permit, you must disclose your conviction and expungement.
What is an expungement? An expungement reopens your criminal case, dismisses and sets aside the conviction, and re-closes the case without a conviction. In effect, you are no longer a convicted person.
More informationDear Applicant: -Page 1 of 2-
Dear Applicant: Thank you for your interest in the Carbon Lehigh Intermediate Unit. The position for which you are applying for has a one step process. Below you will find the instructions for completing
More informationNORCAL Ambulance Employment Application. ( ) - ( ) - Home Phone Cell Phone Address
NORCAL Ambulance Employment Application An Equal Opportunity Employer Please Print Date Last Name First Name Middle Present Address - No. & Street Zip Permanent Address (if different from present address)
More informationTeacher Education Programs Background Check Requirements
Date Received: Received By: Teacher Education Programs Background Check Requirements Application Instructions Complete and submit this application: You have the obligation to complete, sign, and have notarized
More informationHINDS HOSPICE. Employment Application Attn: Human Resources 1616 W. Shaw Suite C-1, Fresno, CA An Equal Opportunity Employer.
HINDS HOSPICE Employment Application Attn: Human Resources 1616 W. Shaw Suite C-1, Fresno, CA 93711 An Equal Opportunity Employer Please Print Date _ Last First Middle Business Telephone ( ) Home Telephone
More informationDEALING WITH UNAUTHORIZED & PROBLEMATIC VISITORS
DEALING WITH UNAUTHORIZED & PROBLEMATIC VISITORS Presentation by Alan B. Harris August 3, 2016 This memorandum addresses legislative tools available to deal with unauthorized visitors and problematic visitors
More informationOREGON ADMINISTRATIVE RULES OREGON DEPARTMENT OF FISH AND WILDLIFE DIVISION 600 CRIMINAL HISTORY CHECK AND FITNESS DETERMINATION RULES
DIVISION 600 CRIMINAL HISTORY CHECK AND FITNESS DETERMINATION RULES 635-600-0000 Statement of Purpose and Statutory Authority Purpose: These rules provide for the Department s acquisition of information
More informationCALIFORNIA PENAL CODE SECTION & 3003(g)[restrictions] W&I [restrictions]
CALIFORNIA PENAL CODE SECTION 290-294 & 3003(g)[restrictions] W&I 6608.5 [restrictions] Chapter 5.5. Sex Offenders Pt. 1, Tit. 9, Ch. 5.5 Note 290. Sex Offender Registration Act; Persons required to register
More informationARKANSAS STATE POLICE SECURITY OR INVESTIGATION BRANCH LOCATION APPLICATION
ARKANSAS STATE POLICE SECURITY OR INVESTIGATION BRANCH LOCATION APPLICATION FOR OFFICE USE ONLY EFFECTIVE 1-7-2019 EXPIRES PROCESSED BY FOR OFFICE USE ONLY: CMPY License Number NOTICE: Information contained
More informationAPPLICATION FOR NON-TEACHING POSITIONS AT LAMS
APPLICATION FOR NON-TEACHING POSITIONS AT LAMS NAME LAST FIRST MIDDLE SOCIAL SECURITY NUMBER 1 PRESENT ADDRESS STREET (AREA CODE) TELEPHONE CITY STATE ZIP CODE E-MAIL ADDRESS (IF AVAILABLE) POSITION APPLIED
More informationTri-City CUSD #1. Employment Application. An Equal Opportunity Employer This Application will be maintained for 12 months only
Tri-City CUSD #1 Employment Application An Equal Opportunity Employer This Application will be maintained for 12 months only Name: Date: (Last Name) (First Name) (Middle) (Number) (Street) (City) (State)
More informationSCHOOL DISTRICT OF PITTSBURGH
No. 920 SECTION: OPERATIONS SCHOOL DISTRICT OF PITTSBURGH TITLE: CLEARANCES/BACKGROUND CHECKS AND REPORTING REQUIREMENTS ADOPTED: March 21, 2007 REVISED: December 17, 2014 920. CLEARANCES/BACKGROUND CHECKS
More informationTEXAS BOARD OF PARDONS AND PAROLES FULL PARDON APPLICATION INSTRUCTIONS
STEP 1: TEXAS BOARD OF PARDONS AND PAROLES FULL PARDON APPLICATION INSTRUCTIONS BEFORE YOU BEGIN, you must have the following documents to complete the application. 1. Offense reports for all arrests,
More informationAuburn CUSD #10. An Equal Opportunity Employer This Application will be maintained for 12 months only. (Number) (Street) (City) (State) (Zip Code)
Auburn CUSD #10 Licensed Employment Application An Equal Opportunity Employer This Application will be maintained for 12 months only Name: Date: (Last Name) (First Name) (Middle) (Number) (Street) (City)
More informationNon-Certified Radiologic Technologist-Registry Application
For Agency Use Code 6213 $60.00 Non-Certified Radiologic Technologist-Registry Application Street Address: 333 Guadalupe, Tower 3, Ste 610, Austin, TX 78701 Mailing Address: PO Box 2029, Austin, TX 78768-2029
More informationRULE 3 1 QUALIFICATIONS FOR ORIGINAL APPOINTMENT
RULE 3 1 QUALIFICATIONS FOR ORIGINAL APPOINTMENT Table of Contents 2 RULE 3 QUALIFICATIONS FOR ORIGINAL APPOINTMENT...1 TABLE OF CONTENTS...1 SECTION 1. QUALIFICATIONS FOR ORIGINAL APPOINTMENT....3 A.
More informationSALESPERSON CHANGE OF EMPLOYER/REACTIVATING LICENSE APPLICATION INSTRUCTIONS AND REQUIREMENTS
Bureau of Professional and Occupational Affairs STATE BOARD OF VEHICLE MANUFACTURERS, DEALERS AND SALESPERSONS PO BOX 2649 HARRISBURG, PA 17105-2649 717-783-1697; 717-787-0250 (Fax) www.dos.state.pa.us/vehicle
More informationASSEMBLY, No STATE OF NEW JERSEY. 215th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 2012 SESSION
ASSEMBLY, No. STATE OF NEW JERSEY th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 0 SESSION Sponsored by: Assemblyman JON M. BRAMNICK District (Morris, Somerset and Union) Co-Sponsored by: Assemblyman
More informationSENECA VALLEY SCHOOL DISTRICT 124 Seneca School Road, Harmony, PA
SENECA VALLEY SCHOOL DISTRICT 124 Seneca School Road, Harmony, PA 16037-9134 APPLICATION FOR CLASSIFIED POSITIONS Important Form Instructions: Use your tab key to proceed to the next field when filling
More informationOblong Community Unit School District #4
Oblong Community Unit School District #4 Employment Application An Equal Opportunity Employer This Application will be maintained for 12 months only Name: Date: (Last Name) (First Name) (Middle) (Number)
More informationJersey CUSD #100. Employment Application An Equal Opportunity Employer This Application will be maintained for 12 months only
Jersey CUSD #100 Employment Application An Equal Opportunity Employer This Application will be maintained for 12 months only Name: Date: (Last Name) (First Name) (Middle) (Number) (Street) (City) (State)
More informationAPPLICATION FOR EMPLOYMENT
APPLICATION FOR EMPLOYMENT Frenchtown School District #40 P.O. Box 117 Frenchtown, Mt 59834 (406) 626-2600 Please type or print clearly using a dark pen. Name: Previous Name(s): Applications and supporting
More informationAssembly Bill No. 602 CHAPTER 139
Assembly Bill No. 602 CHAPTER 139 An act to amend Sections 4057, 4081, and 4301 of, and to add Sections 4025.2, 4084.1, and 4160.5 to, the Business and Professions Code, relating to pharmacy, and declaring
More informationSTANISLAUS COUNTY CLERK-RECORDER APPLICATION FOR CORPORATION / PARTNERSHIP UNLAWFUL DETAINER ASSISTANT CERTIFICATE OF REGISTRATION
STANISLAUS COUNTY CLERK-RECORDER APPLICATION FOR CORPORATION / PARTNERSHIP UNLAWFUL DETAINER ASSISTANT CERTIFICATE OF REGISTRATION Filing Fees: Filing registration: $ 182.00 Each additional ID card: $
More informationNOTICE When submitting your application you will be asked to complete a written test. Please allow approximately 30 minutes to complete testing.
NOTICE Complete applications will be accepted Monday through Friday from 8 am to 3 pm. If you are applying for a specific open position, please include a letter of interest with your completed application.
More informationRULES GOVERNING THE COURTS OF THE STATE OF NEW JERSEY RULE 3:21. SENTENCE AND JUDGMENT; WITHDRAWAL OF PLEA; PRESENTENCE INVESTIGATION; PROBATION
RULES GOVERNING THE COURTS OF THE STATE OF NEW JERSEY RULE 3:21. SENTENCE AND JUDGMENT; WITHDRAWAL OF PLEA; PRESENTENCE INVESTIGATION; PROBATION Rule 3:21-1. Withdrawal of Plea A motion to withdraw a plea
More informationPosition applied for: Date: Human Resources City Hall 5047 Union Street Union City, Georgia 30291
Human Resources City Hall 5047 Union Street Union City, Georgia 30291 All information provided on this application MUST BE COMPLETE so that all applications can be given equitable consideration. All qualified
More informationGRANDFALLS-ROYALTY ISD
GRANDFALLS-ROYALTY ISD PO BOX 10 108 AVE C GRANDFALLS TEXAS 79742 AN EQUAL OPPORTUNITY EMPLOYER 432 547-2266 FAX 432 547-2960 EMPLOYMENT APPLICATION FOR PROFESSIONAL PERSONNEL We consider applicants for
More informationLEGISLATION AFFECTING
LEGISLATION AFFECTING Texas Department of Criminal Justice- Community Justice Assistance Division (TDCJ-CJAD) AND Community Supervision and Corrections Departments (CSCDs) 84th LEGISLATIVE SESSION Adham
More informationApplication of Policy. All applicants for general student employment in a security sensitive position.
Policies of the University of North Texas 05.007 Criminal History Background Checks for Student Employment Applicants Chapter 5 Human Resources Policy Statement. The University of North Texas is committed
More information79th OREGON LEGISLATIVE ASSEMBLY Regular Session. Senate Bill 66
th OREGON LEGISLATIVE ASSEMBLY--0 Regular Session Senate Bill Printed pursuant to Senate Interim Rule. by order of the President of the Senate in conformance with presession filing rules, indicating neither
More informationARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY APPLICATION
ARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY APPLICATION FOR OFFICE USE ONLY EFFECTIVE 12-2016 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public record
More informationAPPLICATION FOR PROFESSIONAL EMPLOYMENT. Presidio Independent School District. An Equal Opportunity Employer. Last First Middle initial
Please print in ink I. Personal Data Date of Application: Name: Current address: APPLICATION FOR PROFESSIONAL EMPLOYMENT Presidio Independent School District An Equal Opportunity Employer Social Security
More informationThe Mission of HPBS is To provide a safe learning environment that ensures quality education while incorporating cultural diversity.
Dear Applicant: Thank you for your interest in applying with Hunters Point Boarding School, Inc. (HPBSI). Hunters Point Board School is a bureau-funded school located in Apache County, approximately five
More informationAll Personnel Criminal Records Searches Adopted: July 23, 2013 Revised: November 12, 2013
All Personnel Criminal Records Searches Adopted: July 23, 2013 Revised: November 12, 2013 D.19 It shall be the policy of the district that it will obtain the results of a national criminal history record
More informationCobb County Emergency Management Agency David Hankerson, Director Cassie Reece, Deputy Director
Annual Criminal History Waiver for Community Emergency Response Teams (CERT) I do hereby authorize the Cobb County Department of Public Safety and/or the Cobb County Emergency Management Agency to receive
More informationPLEASE RETURN COMPLETED VOLUNTEER APPLICATION & WAIVER FORMS TO: Community and Student Services. Grand Rapids Public Schools
PLEASE RETURN COMPLETED VOLUNTEER APPLICATION & WAIVER FORMS TO: Community and Student Services 1331 Franklin SE Grand Rapids, MI 49506 Phone: 616.819.1821 Fax: 616.819.2017 Effective August 2012, ALL
More informationInvoluntary Suspension Without Pay, Demotion, Reduction of Pay Step in Class, or Dismissal of Permanent Classified Employees
Classified Personnel AR 4218(a) DISMISSAL/SUSPENSION/DISCIPLINARY ACTION Termination of Probationary Employment At any time prior to the expiration of the probationary period, the Superintendent or designee
More informationJEFFERSON PARISH CONCEALED HANDGUN PERMIT NEW APPLICATION PACKAGE
JEFFERSON PARISH CONCEALED HANDGUN PERMIT NEW APPLICATION PACKAGE All questions concerning Jefferson Parish Concealed Handgun Permits should be addressed to the JPSO Gun Permit Section, 1233 Westbank Expressway,
More informationWest Rusk County Consolidated Independent School District P.O. Box 168 New London, TX Telephone (903) Fax (903)
West Rusk County Consolidated Independent School District P.O. Box 168 New London, TX 75682 Telephone (903) 392-7850 Fax (903) 392-7866 Employment Application for Service and Support Personnel We consider
More informationEmployment Application
Employment Application Taos Integrated School of the Arts 123 Manzanares Road Post Office Box 668 Taos, New Mexico 87571 (575)758-7755 Fax (575)758-7766 GENERAL INSTRUCTIONS PLEASE NOTE: POSTION APPLYING
More informationMISSISSIPPI LEGISLATURE REGULAR SESSION 2018
MISSISSIPPI LEGISLATURE REGULAR SESSION 2018 By: Representative DeLano To: Corrections HOUSE BILL NO. 232 1 AN ACT TO REQUIRE THAT AN INMATE BE GIVEN NOTIFICATION OF 2 CERTAIN TERMS UPON HIS OR HER RELEASE
More informationBoard -- Establishment and appointment -- Terms -- Officers -- Meetings -- Reimbursement.
63-24-101. Chapter definitions. As used in this chapter, unless the context otherwise requires: (1) "Athletic injury" means any injury sustained by a person as a result of such person's participation in
More informationCHECKLIST OF DOCUMENTS NEEDED FOR THE TEACHER/LIBRARIAN RELATED SERVICES/ADMINISTRATOR CERTIFICATION IN THE CNMI
CHECKLIST OF DOCUMENTS NEEDED FOR THE TEACHER/LIBRARIAN RELATED SERVICES/ADMINISTRATOR CERTIFICATION IN THE CNMI Applicant s Name: Social Security No. EMPLOYEE REQUIREMENTS: Check One: Is the application
More informationGeorgia Weapons Carry License Application Instruction for Completing Application Read these instructions carefully before completing the application.
Georgia Weapons Carry License Application Instruction for Completing Application Read these instructions carefully before completing the application. Following these instructions is the Georgia Weapons
More informationUNOFFICIAL COPY OF HOUSE BILL 774 CHAPTER
UNOFFICIAL COPY OF HOUSE BILL 774 E2 5lr0023 By: Chairman, Judiciary Committee (By Request - Departmental - Public Safety and Correctional Services) Introduced and read first time: February 9, 2005 Assigned
More informationMISSISSIPPI LEGISLATURE REGULAR SESSION 2017
MISSISSIPPI LEGISLATURE REGULAR SESSION 2017 By: Representative DeLano To: Corrections HOUSE BILL NO. 35 1 AN ACT TO REQUIRE THAT AN INMATE BE GIVEN NOTIFICATION OF 2 CERTAIN TERMS UPON HIS OR HER RELEASE
More informationCh. 421a GENERAL PROVISIONS a.1. CHAPTER 421a. GENERAL PROVISIONS
Ch. 421a GENERAL PROVISIONS 58 421a.1 Sec. 421a.1. 421a.2. 421a.3. 421a.4. 421a.5. 421a.6. CHAPTER 421a. GENERAL PROVISIONS General requirements. Disqualification criteria. Investigations; supplementary
More informationApplication for Employment
Application for Employment Today s Date Your Personal Information Name Last First Middle Address City State Zip Code Home Telephone Cellular Telephone E-Mail Address Preferred Method of Contact: Home Telephone
More informationPlease tell us how you heard of Jack Harwell Detention Center. Newspaper Ad. Texas Workforce Commission. On- Line Advertising
Please tell us how you heard of Jack Harwell Detention Center. Newspaper Ad Sign in front of Jack Harwell Employee who works here now and who Texas Workforce Commission Bill Board On- Line Advertising
More information1999 Oregon Laws, Chapter Oregon Laws, Chapter 547 Athletic Trainers
1999 Oregon Laws, Chapter 736 2003 Oregon Laws, Chapter 547 Athletic Trainers (Temporary provisions relating to athletic trainers are compiled as notes following ORS 688.665) (As amended 1/1/06 by HB 2103
More informationEmployment Application
Today s Date Employment Application 424 Prescott St. Greensboro, NC 27401 336-272-4400 This is a Drug-Free Workplace Offering Equal Employment Opportunities YOUR PERSONAL INFORMATION Last Name First Name
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 information