HOW DO WE CONTACT YOU? Shannon Canopy Grove LN Mailing Address* Tallahassee. Florida City* Leon.

Size: px
Start display at page:

Download "HOW DO WE CONTACT YOU? Shannon. 6833 Canopy Grove LN Mailing Address* Tallahassee. Florida City* Leon. srf_esq@comcast."

Transcription

1

2 State of Florida EMPLOYMENT APPLICATION Equal Opportunity Employer/Affirmative Action Employer The State of Florida does not tolerate violence in the workplace. Where to Find Vacancy Information: On the Internet: One Stop Career Centers - Consult your local telephone directory or visit State Agency Human Resources Offices FOR OFFICIAL USE ONLY Agency Authorized Signature Date Broadband Class/Code Status POSITION APPLIED FOR Position Title: EXECUTIVE DIRECTOR-FDLE Date Available: 6/1/15 Position Number: Counties of Interest: Leon Minimum Acceptable Salary: 135,000 GENERAL INSTRUCTIONS FOR COMPLETION OF APPLICATION: The application is NOT submitted until you have electronically signed it by entering your password. If the space provided is not sufficient for all information regarding past employment, education history, etc., attach a resume or other supporting documentation in the same format. All information provided will be a public record and will be released upon request, unless exempt or confidential by law. Applications and supporting documentation must be submitted, no later than 11:59 PM (ET) on the announced deadline date. If, because of a disability, you require a special accommodation to participate in the application and selection process, please notify the hiring authority in advance. All information you submit is subject to verification. EDUCATION HIGH SCHOOL: HOW DO WE CONTACT YOU? Shannon Racquel First Name* Middle Name People First Employee ID Number (if any) 6833 Canopy Grove LN Mailing Address* Tallahassee Florida City* State* Leon (850) County Phone Number* srf_esq@comcast.net Address Fleming Last Name* Zip Code* Alternate Phone Number NAME/LOCATION OF SCHOOL McGill-Toolen in Mobile AL DIPLOMA RECEIVED: Yes YOUR NAME, IF DIFFERENT WHILE ATTENDING SCHOOL: COLLEGE, UNIVERSITY OR PROFESSIONAL SCHOOL: (TRANSCRIPTS MAY BE REQUIRED) NAME OF SCHOOL Florida A& M University Florida State College of Law LOCATION Tallahassee, Fl Tallahassee, Fl DATES OF ATTENDANCE CREDIT HOURS EARNED FROM TO QTR SEM 08/ / / / MAJOR / MINOR COURSE OF STUDY Polical Sci. Law TYPE OF DEGREE EARNED Bachelors Doctorate YOUR NAME, IF DIFFERENT WHILE ATTENDING SCHOOL: LICENSURE, REGISTRATION, CERTIFICATION (EXAMPLES : Teacher Certification, RN, LPN, PE, CPA, etc.) LICENSE, REGISTRATION OR CERTIFICATION Number Date Received Expiration Date State Licensing Agency Florida Bar /1999 Florida Bar

3 JOB-RELATED TRAINING OR COURSE WORK: NAME OF SCHOOL LOCATION (VOCATIONAL, TRADE, GOVERNMENTAL, BUSINESS, ARMED FORCES, ETC.) DATES OF ATTENDANCE CREDIT HOURS EARNED COURSE OF STUDY TRAINING COMPLETED FROM TO CLASS CLOCK YOUR NAME, IF DIFFERENT WHILE ATTENDING TRAINING: KNOWLEDGE / SKILLS / ABILITIES (KSAs) List KSAs you possess and believe relevant to the position you seek, such as operating heavy equipment, computer skills, fluency in language(s), etc. Excellent communication skills Knowledge of basic manangement principles and practices Ability to supervise people Ability to multi-task Ability to assess budgetary needs Ability to formulate policies and procedures Ability to work independently Ability to solve problems and make decisions Ability to conduct fact-finding research Ability to determine work priorities, assign work and ensure completion of work assignments

4 PERIODS OF EMPLOYMENT Describe all work experience in detail, beginning with your current or most recent job. Include military service (indicate rank), internships and job-related volunteer work, if applicable. Indicate number of employees supervised. Use a separate block to describe each position or gap in employment. If needed, attach additional sheets, using the same format as on the application. All information in this section must be completed. Resumes may be attached to provide additional information. Name of Present or Past Employer: E. Jefferson St Assistant Director Lori Holcomb 08/2011 Hours per Week: Duties and Responsibilities: Manage the day- to- day operations of the paralegal program. Review applications of interested paralegals to determine eligibility. Serve as advisory counsel to the Standing Committee. Schedule meetings, prepare agendas and minutes, and make presentations. Manage the records of the program in a manner that complies with all applicable laws. Analyze and make recommendation on substantive rule amendments Draft amendments to The Rules Regulating Created a consumer pamphlet Maintain and update the content of the department s website Prepare and maintain the department s budget and expenses Respond to correspondence or phone inquiries as referred by Executive Director Establish standard of operations for the paralegal program Assume the responsibilities of the director in her absence Collaborate with the technology department to develop new databases and optimize existing databases Name of Previous Employer: 651 E. Jefferson St Tallahassee FL US Assistant Director Carl Zahner (850) Duties and Responsibilities: 01/ /2011 Hours per Week: 38.5 Managed the day-to- day supervision and operations of the department. Worked closely with the members of the Florida Supreme Court s Commission on Professionalism and s Standing Committee in accomplishing their goals. Planned and coordinated Florida Supreme Court Commission meetings and retreats. Prepared annual reports of the Commission s activities. Hired and conducted performance evaluations Developed, monitored and mentored staff Wrote reports and edited newsletters for publication Prepared and maintained the department s budget and expenses Managed and supported compliance of grant requirements and implementation for the organization Recruited and drafted contracts for grant consultants Maintained and updated the content of the department s website Assumed the responsibilities of director in his absence

5 3 Name of Previous Employer: 651 E. Jefferson St Tallahassee FL US Lead Senior Attorney Ken Marvin (850) Duties and Responsibilities: 01/ /2008 Hours per Week: Managed the day-to-day operations of the Grievance Mediation and Arbitration Program. Managed the day-to-day operations of the Attorney Consumer Assistance Program, a legal call center. Screened telephonic and written complaints to provide potential conflict resolution, as deemed appropriate. Conducted preliminary investigations of written complaints to determine if there is a possible ethical rule violation Prepared and administered budgets for three programs Reviewed and approved miscellaneous expense reports and vouchers Made oral presentations Selected, hired, and trained personnel Monitored staff workloads Drafted amendments to The Rules Regulating Maintained and updated the content of the department s website Created a training manual for new employees Conducted performance appraisals Promotion 4 Name of Previous Employer: Agency for Health Care Administration Mahan Dr Tallahassee FL US Senior Attorney Nancy Snurkowski (850) Duties and Responsibilities 09/1999 Hours per Week: 01/ Reviewed complaints and made recommendation to probable cause panels. Drafted pleadings, discovery and legal memoranda. Pursued disciplinary actions for the Boards of Nursing Home Administrator, Psychology, Marriage and Family Therapy, and Clinical Social Workers. Negotiated settlement agreements as a resolution to disciplinary proceedings. Researched and analyzed statutes and regulations Made oral presentations Reviewed investigative and legal files Responded to inquiries from opposing counsel, the public and other agencies Conducted performance appraisal Prepared recommended action for probable cause panels to include dismissals, letters of guidance or administrative complaints Utilized computer case management systems to track activities necessary to bring cases to final resolution Prepared and presented cases before boards Responded to correspondence referred by the Governor s office

6 5 Name of Previous Employer: Pulbic Service Commission Tallahassee FL US Staff Attorney Lila Jaber (850) Duties and Responsibilities: 07/ /1999 Hours per Week: 40 Analyzed customer and utility complaints. Processed requests by public and private utility companies for certification and rate increase. Made recommendations and presentations before the Commission Filed tariffs Career advancement 6 Name of Previous Employer: Hours per Week: Duties and Responsibilities:

7 EXEMPTION FROM PUBLIC RECORDS DISCLOSURE ARE YOU A CURRENT OR FORMER LAW ENFORCEMENT OFFICER, OTHER COVERED EMPLOYEE**, OR THE SPOUSE OR CHILD OF ONE, WHOSE INFORMATION IS EXEMPT FROM PUBLIC RECORDS YES NO DISCLOSURE UNDER SECTION (4)(d), FLORIDA STATUTES (F.S.)?* **Other covered jobs include but are not limited to: correctional and correctional probation officers, firefighters, certain judges, assistant state attorneys, state attorneys, assistant and statewide prosecutors, personnel of the Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child support enforcement, and certain investigators in the Department of Children and Families [see F.S.]. BACKGROUND INFORMATION HAVE YOU EVER BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR?* YES NO If YES, what charges? Where? (City/State) Date: HAVE YOU EVER PLED NOLO CONTENDERE OR PLED GUILTY TO A CRIME WHICH IS A FELONY OR A FIRST DEGREE MISDEMEANOR?* If YES, what charges? YES NO Where? (City/State) Date: HAVE YOU EVER HAD THE ADJUDICATION OF GUILT WITHELD FOR A CRIME WHICH IS A FELONY OR A FIRST DEGREE MISDEMEANOR?* If YES, what charges? YES NO Where? (City/State) Date: NOTE: A YES answer to these questions will not automatically bar you from employment. The nature, job-relatedness, severity and date of the offense in relation to the position for which you are applying are considered [see , F.S.] CITIZENSHIP The state of Florida hires only U.S. citizens and lawfully authorized alien workers. You will be required to provide identification and either proof of citizenship or proof of authorization to work in the U.S. 1. ARE YOU A U.S. CITIZEN?* YES NO 2. IF NO, ARE YOU LEGALLY AUTHORIZED TO ACCEPT EMPLOYMENT WITH THE SPECIFIC HIRING AUTHORITY TO WHICH YOU ARE APPLYING?* YES NO RELATIVES TO YOUR KNOWLEDGE, DO YOU HAVE ANY RELATIVES WORKING IN THIS AGENCY?* SELECTIVE SERVICE SYSTEM REGISTRATION YES NO Section , Florida Statutes, prohibits employment by the State (including re-hire after a break in service) of any male born after October 1, 1962, who failed to register with the Selective Service System, under the provisions of the U.S. Military Selective Service Act, during the person's period of eligibility (ages 18 through 25). Additionally, if currently employed by the State, this law prohibits the promotion of such person. IF YOU ARE A MALE BORN ON OR AFTER OCTOBER 1, 1962, HAVE YOU REGISTERED WITH THE SELECTIVE SERVICE OR DO YOU HAVE PROOF OF AN EXEMPTION FROM THIS REQUIREMENT YES NO N/A (DOCUMENTATION MAY BE REQUIRED )?* CERTIFICATION I am aware that any omissions, falsifications, misstatements, or misrepresentations above may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I consent to the release of information about my ability, employment history, and fitness for employment by employers, schools, law enforcement agencies, and other individuals and organizations to investigators, human resources staff, and other authorized employees of Florida state government for employment purposes. This consent shall continue to be effective during my employment if I am hired. I understand that applications submitted for state employment are public records. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith. SIGNED ELECTRONICALLY BY: Shannon Fleming 05/15/2015

8 Shannon R. Fleming 6833 Canopy Grove Ln. Phone: ATTORNEY Regulatory AttorneyBar CounselAssistant Director 17 years of legal experience 15 years of managerial experience Knowledgeable in legal research and analysis, settlement negotiations, conflict resolution, and document drafting Provided Counsel to Boards, Commissions, and Committees Proven ability to logically and effectively analyze ethical rules, statutes, and case law Outstanding ability to be concise, logical, objective, persuasive in both written and oral communications. Resourceful individual with the ability to evaluate all issues and complete projects in a timely fashion. Flexible, versatile and able to maintain a sense of humor under pressure. Highly skilled at being able to motivate teams to achieve objective or work independently Legal Research and Writing Office Management Staff Development & Training Teambuilding & Supervision Analytical Reasoning Skills Training Labor Laws by Gonzalez Firm, 2010 Excelling as a Manager or Supervisor, 2011 Business Writing for Results, 2011 HR Law, 2011 Diversity Sensitivity Training, 2012 How to Excel at Managing & Supervising People, 2013 Coaching and Teambuilding Skills for Managers & Supervisors, 2014 Customer Service Problem Solving Complaint Resolution Budget Development Fiscal Management Professional Experience Registered Paralegal Program Assistant Director August 2011-present Manage the day- to- day operations of the paralegal program. Review applications of interested paralegals to determine eligibility. Serve as advisory counsel to the Standing Committee. Schedule meetings, prepare agendas and minutes, and make presentations. Manage the records of the program in a manner that complies with all applicable laws. Analyze and make recommendation on substantive rule amendments Draft amendments to The Rules Regulating Created a consumer pamphlet Maintain and update the content of the department s website Prepare and maintain the department s budget and expenses Respond to correspondence or phone inquiries as referred to by Executive Director Established standard of operations for the paralegal program Assume the responsibilities of the director in her absence Collaborate with the technology department to develop new databases and optimize existing databases Henry Latimer Center for Professionalism Assistant Director January Managed the day-to- day supervision and operations of the department. Worked closely with the members of the Florida Supreme Court s Commission on Professionalism and s Standing Committee in accomplishing their goals. Planned and coordinated Florida Supreme Court Commission meetings and retreats. Prepared annual reports of the Commission s activities.

9 Hired and conducted performance evaluations Developed, monitored and mentored staff Wrote reports and edited newsletters for publication Prepared and maintained the department s budget and expenses Managed and supported compliance of grant requirements and implementation for the organization Prepared final report to funding source of the grant Researched other grant funding sources opportunities Recruited and drafted contracts for grant consultants Collected data on attorney misconduct to assist in the development of professionalism programs Maintained and updated the content of the department s website Reviewed applications for approval of professionalism continuing education credit Assumed the responsibilities of director in his absence Attorney Consumer Assistance Program Lead Senior Attorney January Managed the day-to-day operations of the Grievance Mediation and Arbitration Program. Managed the day-to-day operations of the Attorney Consumer Assistance Program, a legal call center. Screened telephonic and written complaints to provide potential conflict resolution, as deemed appropriate. Conducted preliminary investigations of written complaints to determine if there is a possible ethical rule violation. Prepared and administered budgets for three programs Reviewed and approved miscellaneous expense reports and vouchers Reviewed time sheets and leave reports Prepared and reviewed statistical information and reports Made oral presentations Selected, hired, and trained personnel Monitored staff workloads Drafted amendments to The Rules Regulating Arranged meetings Utilized computer case management to track case activities Drafted and updated consumer pamphlets, as necessary Maintained and updated the content of the department s website Increased the number of mediator/arbitrator volunteers and reduced backlog of cases Created a training manual for new employees Conducted performance appraisals Agency for Health Care Administration Allied Health September Senior Attorney Reviewed complaints and made recommendation to probable cause panels. Drafted pleadings, discovery and legal memoranda. Pursued disciplinary actions for the Boards of Nursing Home Administrator, Psychology, Marriage and Family Therapy, and Clinical Social Workers. Negotiated settlement agreements as a resolution to disciplinary proceedings. Researched and analyzed statutes and regulations Prepared pleadings Made oral presentations Reviewed investigative and legal files Responded to inquiries from opposing counsel, the public and other agencies Conducted performance appraisal Prepared recommended action for probable cause panels to include dismissals, letters of guidance or administrative complaints Utilized computer case management systems to track activities necessary to bring cases to final resolution Prepared and presented cases before boards Responded to correspondence referred by the Governor s office

10 Florida Public Service Commission Water and Waste Water Division Staff Attorney July Analyzed customer and utility complaints. Processed requests by public and private utility companies for certification and rate increase. Made recommendations and presentations before the Commission Filed tariffs Education The Florida State University College of Law Juris Doctor May 1997 Florida A&M University Bachelor of Science in Political Science, Magna Cum Laude April 1994 Bar Admission Florida, 1999

HOW DO WE CONTACT YOU? James. County. s. 119.071(4)(d)2.a.(I) F.S. E-Mail Address DIPLOMA RECEIVED: DATES OF ATTENDANCE (MM/YYYY) 04/2014 04/2017

HOW DO WE CONTACT YOU? James. County. s. 119.071(4)(d)2.a.(I) F.S. E-Mail Address DIPLOMA RECEIVED: DATES OF ATTENDANCE (MM/YYYY) 04/2014 04/2017 State of Florida EMPLOYMENT APPLICATION Equal Opportunity Employer/Affirmative Action Employer The State of Florida does not tolerate violence in the workplace. Where to Find Vacancy Information: On the

More information

HOW DO WE CONTACT YOU? Radhika. 603 E. Call St. Apt. 930 Mailing Address* Tallahassee. Florida City* Leon. rpuri518@comcast.

HOW DO WE CONTACT YOU? Radhika. 603 E. Call St. Apt. 930 Mailing Address* Tallahassee. Florida City* Leon. rpuri518@comcast. State of Florida EMPLOYMENT APPLICATION Equal Opportunity Employer/Affirmative Action Employer The State of Florida does not tolerate violence in the workplace. Where to Find Vacancy Information: On the

More information

State of Florida EDUCATION FOR OFFICIAL USE ONLY POSITION APPLIED FOR GENERAL INSTRUCTIONS FOR COMPLETION OF APPLICATION: HOW DO WE CONTACT YOU?

State of Florida EDUCATION FOR OFFICIAL USE ONLY POSITION APPLIED FOR GENERAL INSTRUCTIONS FOR COMPLETION OF APPLICATION: HOW DO WE CONTACT YOU? State of Florida EMPLOYMENT APPLICATION Equal Opportunity Employer/Affirmative Action Employer The State of Florida does not tolerate violence in the workplace. Where to Find Vacancy Information: On the

More information

HOW DO WE CONTACT YOU? Patrice. 20 Frank Run Mailing Address* Midway. Florida City* GADSDEN. spicerp@ahca.myflorida.

HOW DO WE CONTACT YOU? Patrice. 20 Frank Run Mailing Address* Midway. Florida City* GADSDEN. spicerp@ahca.myflorida. State of Florida EMPLOYMENT APPLICATION Equal Opportunity Employer/Affirmative Action Employer The State of Florida does not tolerate violence in the workplace. Where to Find Vacancy Information: On the

More information

If Service Center determines elig bility for a different VP category than claimed Not Set

If Service Center determines elig bility for a different VP category than claimed Not Set Layoff Status: No VP Category Claimed: None of the Above People First Eligible VP Category (if different): If Service Center determines elig bility for a different VP category than claimed Not Set Agency

More information

Office of the Attorney General Attn: Personnel The Capitol - PL01 Tallahassee, FL 32399-1050

Office of the Attorney General Attn: Personnel The Capitol - PL01 Tallahassee, FL 32399-1050 A State of Florida Job Application Form is contained on the next four pages. You may print the form, complete the information and mail to the Office of the Attorney General. Please include the position

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION LAW OFFICE OF MATTHEW Z. MARTELL P.A. EMPLOYMENT APPLICATION EQUAL OPPORTUNITY EMPLOYER MAILING ADDRESS: 1800 2 nd Street, Suite 882 Sarasota, Florida 34236 941-556-7020 941-556-0521 FAX APPLICATION INSTRUCTIONS:

More information

No Were you in the military during a wartime activity? Note: Certain positions are exempt from request for Veterans Preference. Dates (Mo./Yr.

No Were you in the military during a wartime activity? Note: Certain positions are exempt from request for Veterans Preference. Dates (Mo./Yr. NAME (Print): Last First Preferred Name Middle ADDRESS: Street City State Zip Telephone: Home Work Cell E-MAIL ADDRESS: Home Work Other POSITION APPLYING FOR: VACANCY NUMBER: VETERANS PREFERENCE: Yes No

More information

Application for Employment

Application for Employment ANGELA B. COREY ST AT E A TT ORNEY STATE ATTORNEY Fourth Judicial Circuit of Florida Ed Austin Building 311 West Monroe Street Jacksonville, Florida 32202-4242 Tel: (904) 255-2500 Fax: (904) 255-2942 Application

More information

How To Become A Lsecretary Of Environment Protection

How To Become A Lsecretary Of Environment Protection Requisition - 37010001-51192559-20150511163013 ( SECRETARY OF ENVIRONMENTAL PROTECTION ) Applicant - George Bruder Applicant Profile Including Qualifying Questions EEO & Veterans' Preference Information

More information

Name: Last First Middle. Mailing Address: Street City/State Zip Street Address: Street City/State Zip Telephone: ( ) Social Security Number:

Name: Last First Middle. Mailing Address: Street City/State Zip Street Address: Street City/State Zip Telephone: ( ) Social Security Number: School Nurse Application for Employment TANQUE VERDE UNIFIED SCHOOL DISTRICT, NO. 13 11150 E. Tanque Verde Road Tucson, AZ 85749 520-749-5751 / fax 520-749-5400 All positions require an Arizona Registered

More information

Inquiry Concerning A Florida Lawyer

Inquiry Concerning A Florida Lawyer Inquiry Concerning A Florida Lawyer This pamphlet provides general information relating to the purpose and procedures of the Florida lawyer discipline system. It should be read carefully and completely

More information

HUMBOLDT COUNTY EMPLOYMENT APPLICATION

HUMBOLDT COUNTY EMPLOYMENT APPLICATION Name Address HUMBOLDT COUNTY EMPLOYMENT APPLICATION An Equal Opportunity If you believe you require an accommodation during the selection process, please contact us to make appropriate arrangements. Date

More information

APPLICATION FOR LICENSURE AS A PSYCHOLOGIST

APPLICATION FOR LICENSURE AS A PSYCHOLOGIST APPLICATION FOR LICENSURE AS A PSYCHOLOGIST Application Fee: $40 (Nonrefundable) File #: SECTION I. PErSONAl DATA (Board use only) Last First Middle Initial Jr., Sr., I, II (Note: Formal identification

More information

New Jersey Physician Recredentialing Application (Please type or print)

New Jersey Physician Recredentialing Application (Please type or print) New Jersey Physician Recredentialing Application (Please type or print) All sections must be completed fully or clearly marked as not applicable. No area should be left blank. SECTION 1 Personal Information

More information

FIRE FIGHTER APPLICATION PACKAGE

FIRE FIGHTER APPLICATION PACKAGE FIRE FIGHTER APPLICATION PACKAGE APPLICATION CLOSING DATE AND LOCATION: TUESDAY, NOVEMBER 8, 2011 AT 5:00 P.M. (CENTRAL STANDARD TIME) HUMAN RESOURCES DEPARTMENT 1110 HOUSTON STREET, LAREDO, TEXAS 78042

More information

APPLICATION FOR NATIONAL EXAMINATION IN MARITAL & FAMILY THERAPY

APPLICATION FOR NATIONAL EXAMINATION IN MARITAL & FAMILY THERAPY Minnesota Board of Marriage and Family Therapy 2829 University Avenue SE, Suite 400 Minneapolis, MN 55414-3222 Telephone: (612) 617-2220 Fax: (612) 617-2221 Email: mft.board@state.mn.us Website: www.bmft.state.mn.us

More information

Interviews. Hiring. Orientation

Interviews. Hiring. Orientation FLORENCE-DARLINGTON TECHNICAL COLLEGE Human Resources Department P.O. Box 100548 Florence, SC 29501-0548 Phone (843) 661-8320 Fax (843) 661-8371 Web Address: http://www.fdtc.edu Applicant Information and

More information

ADAM H. PUTNAM COMMISSIONER

ADAM H. PUTNAM COMMISSIONER FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES ADAM H. PUTNAM COMMISSIONER PROFESSIONAL FUNDRAISING CONSULTANT REGISTRATION APPLICATION Chapter 496, Florida Statutes Rule 5J-7.009, Florida Administrative

More information

Louisiana School for Math, Science, and the Arts - Application for Employment

Louisiana School for Math, Science, and the Arts - Application for Employment Louisiana School for Math, Science, and the Arts - Application for Employment The Louisiana School for Math, Science, and the Arts does not discriminate in employing persons on the basis of race, creed,

More information

CITY OF BAKERSFIELD EMPLOYMENT APPLICATION

CITY OF BAKERSFIELD EMPLOYMENT APPLICATION CITY OF BAKERSFIELD EMPLOYMENT APPLICATION CITY OF BAKERSFIELD HUMAN RESOURCES OFFICE Office Address: 1600 Truxtun Ave., 1 st Floor Mailing Address 1600 Truxtun Ave. Bakersfield, CA 93301 APPLICATION FOR

More information

Application for an Addition to a Minnesota Education License (Teaching, Administrative, Related Services) Sections 1 and 2: APPLICANT INFORMATION

Application for an Addition to a Minnesota Education License (Teaching, Administrative, Related Services) Sections 1 and 2: APPLICANT INFORMATION Application for an Addition to a Minnesota Education License (Teaching, Administrative, Related Services) ED-02443-13 Submit a completed application and required items in ONE envelope to: o o o Partial

More information

STATE OF TENNESSEE EMPLOYMENT APPLICATION

STATE OF TENNESSEE EMPLOYMENT APPLICATION USE BLACK INK ONLY TO COMPLETE THIS APPLICATION FORM. REQUIRED FIELDS OR YOUR APPLICATION WILL BE RETURNED TO YOU. PLEASE COMPLETE ALL Please record your Social Security Number below. List the specific

More information

City of Sturgis Fire Department

City of Sturgis Fire Department City of Sturgis Fire Department Employment Application And Personal History Statement AN EQUAL OPPORTUNITY EMPLOYER 1 GENERAL INFORMATION Read Carefully Before You Complete This Application NOTICE: Print

More information

Note: We do not buy out Law Enforcement Contracts.

Note: We do not buy out Law Enforcement Contracts. Sheriff s Office Applicants Re: Application Process In order to speed your application process, only submit your application after you have obtained all of the following information: Complete an application

More information

Personal Information

Personal Information Forsyth R-III School District P.O. Box 187 Forsyth, MO 65653 Phone: 417-546-6384 Fax: 417-546-2204 Certified Personnel Employment Application Personal Information Last Name First Middle Date Street City,

More information

Florida Senate - 2016 SB 336

Florida Senate - 2016 SB 336 By Senator Richter 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 A bill to be entitled An act relating to property insurance appraisals; creating part XIV of ch. 626, F.S.,

More information

CITY OF NORTH MIAMI BEACH

CITY OF NORTH MIAMI BEACH CITY OF NORTH MIAMI BEACH APPLICATION FOR EMPLOYMENT AN EQUAL OPPORTUNITY EMPLOYER INSTRUCTIONS: Please fill out this application accurately and completely. PLEASE PRINT CLEARLY or type all information.

More information

INFORMATION/INSTRUCTION SHEET CERTIFIED PODIATRIC X-RAY ASSISTANT

INFORMATION/INSTRUCTION SHEET CERTIFIED PODIATRIC X-RAY ASSISTANT Chapter 461, Florida Statutes Rule Chapter 64B18-24, Florida Administrative Code INFORMATION/INSTRUCTION SHEET CERTIFIED PODIATRIC X-RAY ASSISTANT Any Certified Podiatric X-ray Assistant may perform services

More information

APPLICANT INSTRUCTIONS

APPLICANT INSTRUCTIONS APPLICANT INSTRUCTIONS Thank you for your interest in employment with our Company. We appreciate your application, and look forward to the possibility of you joining our team. This sheet is for your information.

More information

CHAPTER 20. FLORIDA REGISTERED PARALEGAL PROGRAM 20-1. PREAMBLE RULE 20-1.1 PURPOSE

CHAPTER 20. FLORIDA REGISTERED PARALEGAL PROGRAM 20-1. PREAMBLE RULE 20-1.1 PURPOSE CHAPTER 20. FLORIDA REGISTERED PARALEGAL PROGRAM 20-1. PREAMBLE RULE 20-1.1 PURPOSE The purpose of this chapter is to set forth a definition that must be met in order to use the title paralegal, to establish

More information

INSTRUCTIONS FOR HEARING AID DISPENSING APPLICATION

INSTRUCTIONS FOR HEARING AID DISPENSING APPLICATION BOARDS AND COMMISSIONS DIVISION New Mexico Speech-Language Pathology, Audiology and Hearing Aid Dispensing Practices Board PO Box 25101 Santa Fe, New Mexico 87505 (505) 476-4640 Fax (505) 476-4620 www.rld.state.nm.us

More information

PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made

PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made available to any person upon request. This application

More information

HOW TO COMPLETE THE EMPLOYMENT APPLICATION Thank you for your interest in employment with the Tohono O odham Nation!

HOW TO COMPLETE THE EMPLOYMENT APPLICATION Thank you for your interest in employment with the Tohono O odham Nation! Tohono O odham Nation Executive Branch HUMAN RESOURCES OFFICE P.O. Box 837, Sells Arizona 85634 Phone: (520) 383-6540 Fax: (520) 383-4676 (520) 361-3766, (520) 362-3766, Tucson Line: (520) 623-5783 Website:

More information

PROJECT 375 EMPLOYMENT APPLICATION

PROJECT 375 EMPLOYMENT APPLICATION PROJECT 375 EMPLOYMENT APPLICATION Thank you for your interest in PROJECT 375. Our application process is built to ensure the very best experience for you the applicant. Please follow these instructions

More information

How To Become A Court Appointed Attorney

How To Become A Court Appointed Attorney Court Appointed Attorney Application Ninth Judicial Circuit (Orange and Osceola Counties) Florida law requires that the Chief Judge of the Circuit compile a list of attorneys in private practice, by county

More information

APPLICATION FOR EMPLOYMENT MANAGEMENT POSITIONS

APPLICATION FOR EMPLOYMENT MANAGEMENT POSITIONS Taft College Human Resources Department West Kern Community College District 29 Emmons Park Drive, Taft, California 93268 Phone (661) 763-7805 www.taftcollege.edu APPLICATION FOR EMPLOYMENT MANAGEMENT

More information

BOARD OF CHIROPRACTIC MEDICINE GENERAL INFORMATION/INSTRUCTIONS REGISTERED CHIROPRACTIC ASSISTANT

BOARD OF CHIROPRACTIC MEDICINE GENERAL INFORMATION/INSTRUCTIONS REGISTERED CHIROPRACTIC ASSISTANT BOARD OF CHIROPRACTIC MEDICINE GENERAL INFORMATION/INSTRUCTIONS REGISTERED CHIROPRACTIC ASSISTANT HOW TO APPLY FOR FLORIDA LICENSURE *** PLEASE TYPE OR PRINT IN BLACK INK - PLEASE READ CAREFULLY *** 1.

More information

Y- AmeriCorps Application

Y- AmeriCorps Application Y- AmeriCorps Application PERSONAL PROFILE NAME: LAST FIRST MIDDLE Are you a United States citizen, national, or lawful permanent resident alien? Yes No If you are a lawful permanent resident alien and

More information

Application Packet. Hopewell Page 1

Application Packet. Hopewell Page 1 Application Packet Caregivers who are interested must fill out an application and return it with all necessary documents to our office. Completed applications can be faxed to 850-386-5505 (Tallahassee)

More information

SCCJA Diploma Requirements - Important Questions to Ask

SCCJA Diploma Requirements - Important Questions to Ask Fax 864-898-5531 Rick Clark OFFICE PHONES SHERIFF, P ICKENS COUNTY 864-898-5500 216 C. David Stone Rd. 864-868-2603 Pick en s, Sou th C aroli na 29671 Re: Sheriff s Office Applicants Application Process

More information

BOARD OF CHIROPRACTIC MEDICINE GENERAL INFORMATION/INSTRUCTIONS TO MODIFY SUPERVISION FOR CERTIFIED CHIROPRACTIC PHYSICIANS ASSISTANT

BOARD OF CHIROPRACTIC MEDICINE GENERAL INFORMATION/INSTRUCTIONS TO MODIFY SUPERVISION FOR CERTIFIED CHIROPRACTIC PHYSICIANS ASSISTANT BOARD OF IROPRACTIC MEDICINE GENERAL INFORMATION/INSTRUCTIONS TO MODIFY SUPERVISION FOR CERTIFIED IROPRACTIC PHYSICIANS ASSISTANT HOW TO APPLY FOR FLORIDA LICENSURE *** PLEASE TYPE OR PRINT IN BLACK INK

More information

EXAMINATION INFORMATION FOR PROSPECTIVE TEXAS CPA APPLICANTS

EXAMINATION INFORMATION FOR PROSPECTIVE TEXAS CPA APPLICANTS EXAMINATION INFORMATION FOR PROSPECTIVE TEXAS CPA APPLICANTS This brochure contains current information relative to applying for the Uniform CPA Examination under the jurisdiction of the Texas State Board

More information

Disregard all information in the paper application packet regarding fingerprinting!

Disregard all information in the paper application packet regarding fingerprinting! Disregard all information in the paper application packet regarding fingerprinting! If you anticipate having your fingerprints received by the Board office after January 1, 2013 do not use a paper fingerprint

More information

Instructions for completion:

Instructions for completion: Application for Employment Instructions for completion: Human Resources Office One Angwin Avenue Angwin, CA 94508 707-965-6231 707-965-6400 (fax) hr@puc.edu (e-mail ) 1. Save this document before proceeding.

More information

Board of Speech-Language Pathology and Audiology

Board of Speech-Language Pathology and Audiology Board of Speech-Language Pathology and Audiology Application for Speech-Language Pathology or Audiology Provisional Licensure With Instructions Attached Board of Speech-Language Pathology and Audiology

More information

Application For Employment

Application For Employment Application For Employment DISC Village, Inc. 3333 West Pensacola St. #330 Tallahassee, FL 32304 (850) 575-4388 (850) 576-3317 [FAX] WE ARE AN EQUAL OPPORTUNITY EMPLOYER We consider applicants for all

More information

Application Checklist

Application Checklist Application Checklist POSITION APPLIED FOR: Indian Preference shall not be claimed without proof. Submitted applications without copies of verification documents, unanswered questions, omitted dates, omitted

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION SPALDING COUNTY BOARD OF COMMISSIONERS 119 E. Solomon Street, P.O. Box 1087 Griffin, Georgia 30224 www.spaldingcounty.com EMPLOYMENT APPLICATION SPALDING COUNTY ONLY ACCEPTS APPLICATIONS FOR CURRENTLY

More information

State of Hawaii Department of Health Adult Mental Health Division Halawa to Kalihi, Oahu

State of Hawaii Department of Health Adult Mental Health Division Halawa to Kalihi, Oahu State of Hawaii Department of Health Adult Mental Health Division Halawa to Kalihi, Oahu AMHD Case Management Specialist $3,951 - $4,117 monthly, commensurate w/ training and experience The primary function

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT 37248 PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS HUMAN RESOURCES www.pbcgov.jobs 100 Australian Avenue Suite 300 West Palm Beach, Florida 33406 JOB HOTLINE 561-616-6900 FAX 561-616-6893 APPLICATION

More information

CHAPTER 20. FLORIDA REGISTERED PARALEGAL PROGRAM 20-1. PREAMBLE. The purpose of this chapter is to set forth a definition that must be met in order to

CHAPTER 20. FLORIDA REGISTERED PARALEGAL PROGRAM 20-1. PREAMBLE. The purpose of this chapter is to set forth a definition that must be met in order to 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 1115 1116 1117 1118 1119 1120 1121 1122 1123 1124 1125 1126 1127 CHAPTER 20. FLORIDA REGISTERED PARALEGAL PROGRAM 20-1. PREAMBLE Rule 20-1.1.

More information

STANDARD APPLICATION For Teaching Positions in Pennsylvania Public Schools

STANDARD APPLICATION For Teaching Positions in Pennsylvania Public Schools STANDARD APPLICATION For Teaching Positions in Pennsylvania Public Schools (PLEASE PRINT OR TYPE) POSITION(S) DESIRED NAME LAST FIRST MIDDLE SOCIAL SECURITY NUMBER 1 PRESENT ADDRESS STREET (AREA CODE)

More information

STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION

STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION STATE OF FLORIDA OFFICE OF FINANCIAL REGULATION Registration of Crowdfunding Intermediary Application (Form FL-INT) Pursuant to Section 517.12, Florida Statutes GENERAL INSTRUCTIONS An intermediary of

More information

BOARD OF CHIROPRACTIC MEDICINE. Application Instructions for Chiropractic Medical Faculty Certificate

BOARD OF CHIROPRACTIC MEDICINE. Application Instructions for Chiropractic Medical Faculty Certificate BOARD OF CHIROPRACTIC MEDICINE Application Instructions for Chiropractic Medical Faculty Certificate Fees: Please send a total fee of $205.00 (certified check or money order) payable to the Department

More information

PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made

PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRSA 401 et seq). Public records must be made available to any person upon request. This application

More information

NC General Statutes - Chapter 90B 1

NC General Statutes - Chapter 90B 1 Chapter 90B. Social Worker Certification and Licensure Act. 90B-1. Short title. This Chapter shall be known as the "Social Worker Certification and Licensure Act." (1983, c. 495, s. 1; 1999-313, s. 1.)

More information

First Middle Last. Number and Street City State Zip Code Home Telephone # Work Telephone #

First Middle Last. Number and Street City State Zip Code Home Telephone # Work Telephone # EMPLOYMENT APPLICATION Fire Department City of Sterling, Colorado 421 N. 4 th St., P.O. Box 4000 Sterling, CO 80751-0400 Phone (970) 522-9700 FAX (970)521-0632 www.sterlingcolo.com An Equal Opportunity

More information

Department of Education Alternative Route to Certification Program Application

Department of Education Alternative Route to Certification Program Application Certification Office 800 Governors Drive Pierre, South Dakota 57501 certification@state.sd.us Telephone: 605.773.3426 Department of Education Alternative Route to Certification Program Application Instructions

More information

BOARD OF CHIROPRACTIC MEDICINE GENERAL INFORMATION/INSTRUCTIONS CERTIFIED CHIROPRACTIC PHYSICIANS ASSISTANT

BOARD OF CHIROPRACTIC MEDICINE GENERAL INFORMATION/INSTRUCTIONS CERTIFIED CHIROPRACTIC PHYSICIANS ASSISTANT BOARD OF CHIROPRACTIC MEDICINE GENERAL INFORMATION/INSTRUCTIONS CERTIFIED CHIROPRACTIC PHYSICIANS ASSISTANT HOW TO APPLY FOR FLORIDA LICENSURE *** PLEASE TYPE OR PRINT IN BLACK INK - PLEASE READ CAREFULLY

More information

DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292

DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292 DIVISION OF MEDICAL QUALITY ASSURANCE BOARD OF PHARMACY 4052 BALD CYPRESS WAY, BIN #C-04 TALLAHASSEE, FLORIDA 32399-3254 (850) 245-4292 PHARMACY TECHNICIAN REGISTRATION APPLICATION AND INSTRUCTIONS October

More information

Michael Gayoso, Jr. Office of the County Attorney TH

Michael Gayoso, Jr. Office of the County Attorney TH Michael Gayoso, Jr. Office of the County Attorney TH 11 Judicial District/Crawford County, Kansas DIVERSION PROGRAM -- DRIVING UNDER THE INFLUENCE Pursuant to K.S.A. 22-2906 et seq. the Crawford County

More information

Criminal Justice Institute

Criminal Justice Institute May 22, 2014 Dear Student: Thank you for your interest in obtaining your Florida certification as a law enforcement or correctional officer. The Equivalency-of-Training process enables one to become exempt

More information

INDIANAPOLIS JEWISH HOME, INC. ("HOOVERWOOD")

INDIANAPOLIS JEWISH HOME, INC. (HOOVERWOOD) INDIANAPOLIS JEWISH HOME, INC. ("HOOVERWOOD") APPLICATION FOR EMPLOYMENT Indianapolis Jewish Home, Inc. ("Hooverwood") is an equal opportunity employer. Applicants are considered for employment without

More information

2015-2016 APPLICATION

2015-2016 APPLICATION 2015-2016 APPLICATION A City of Richmond Community Building Collaborative The AmeriCorps ACES (Action for Community Enhancement Services) program is available to all without regard to race, color, national

More information

State of Hawaii Department of Health Child and Adolescent Mental Health Division Manoa - Kahala, Oahu

State of Hawaii Department of Health Child and Adolescent Mental Health Division Manoa - Kahala, Oahu State of Hawaii Department of Health Child and Adolescent Mental Health Division Manoa - Kahala, Oahu Child and Adolescent Mental Health Division System of Care System Spanner $45,000 - $54,996 yearly,

More information

BEXAR APPRAISAL DISTRICT 411 NORTH FRIO, SAN ANTONIO, TEXAS 78207 APPLICATION FOR EMPLOYMENT

BEXAR APPRAISAL DISTRICT 411 NORTH FRIO, SAN ANTONIO, TEXAS 78207 APPLICATION FOR EMPLOYMENT BEXAR APPRAISAL DISTRICT 411 NORTH FRIO, SAN ANTONIO, TEXAS 78207 APPLICATION FOR EMPLOYMENT BEXAR APPRAISAL DISTRICT IS AN EQUAL OPPORTUNITY EMPLOYER Applicants are considered for all positions without

More information

recognition and retention to include the pursuit of professional certifications for career enhancement and professional stature. Expand staff s investigative capabilities by creating an environment which

More information

Criminal Justice Selection Center

Criminal Justice Selection Center Send all mail to: Gulf Coast Criminal Justice Selection Center http://www.gulfcoast.edu/north_bay/selection Our physical location: Criminal Justice Selection Center North Bay Campus, Abbott Building 5230

More information

Board of Speech-Language Pathology and Audiology

Board of Speech-Language Pathology and Audiology Board of Speech-Language Pathology and Audiology Application for Speech-Language Pathology or Audiology Assistant Certification With Instructions Attached Board of Speech-Language Pathology and Audiology

More information

D. EDUCATION/TRAINING

D. EDUCATION/TRAINING MOUNTAIN HOME POLICE DEPARTMENT EMPLOYMENT APPLICATION Positive, Professional, Productive, Proactive An Equal Opportunity Employer Applicant Full Name: Date: A. INSTRUCTIONS Application must be typewritten

More information

FLORIDA REGISTERED PARALEGAL APPLICATION CHAPTER 20, RULES REGULATING THE FLORIDA BAR

FLORIDA REGISTERED PARALEGAL APPLICATION CHAPTER 20, RULES REGULATING THE FLORIDA BAR FLORIDA REGISTERED PARALEGAL APPLICATION CHAPTER 20, RULES REGULATING THE FLORIDA BAR I. PERSONAL INFORMATION Please Type or Print 1. Name: Please complete the information in Item 1 as you wish it to appear

More information

Application Letter of Instruction

Application Letter of Instruction STATE OF NEVADA BOARD OF OCCUPATIONAL THERAPY P.O. BOX 34779 Reno, Nevada 89533-4779 (775) 746-4101 / Fax: (775) 746-4105 / Toll Free: (800) 431-2659 Email: board@nvot.org / Website: www.nvot.org TYPES

More information

APPLICANT CHECKLIST. The following documents must be submitted at the time of application:

APPLICANT CHECKLIST. The following documents must be submitted at the time of application: APPLICANT CHECKLIST The following documents must be submitted at the time of application: 1. Birth Certificate 2. High School Diploma or G.E.D. Certificate 3. College Degree & Transcript (if applicable)

More information

CHAPTER 5 CERTIFICATE STATUS MAINTENANCE C.R.S. 1973, 12-2-108, 12-2-119(5), 12-2-122.5 and 12-2-123

CHAPTER 5 CERTIFICATE STATUS MAINTENANCE C.R.S. 1973, 12-2-108, 12-2-119(5), 12-2-122.5 and 12-2-123 CHAPTER 5 CERTIFICATE STATUS MAINTENANCE C.R.S. 1973, 12-2-108, 12-2-119(5), 12-2-122.5 and 12-2-123 Sections 12-2-108, 12-2-115.5, 12-2-119(5), 12-2-122.5, 12-2-123 and 24-34-102(8)(d), C.R.S. 5.1 INTRODUCTION

More information

STATE OF FLORIDA BOARD OF MASSAGE THERAPY MASSAGE ESTABLISHMENT CHANGE OF LOCATION/ NAME APPLICATION WITH INSTRUCTIONS

STATE OF FLORIDA BOARD OF MASSAGE THERAPY MASSAGE ESTABLISHMENT CHANGE OF LOCATION/ NAME APPLICATION WITH INSTRUCTIONS STATE OF FLORIDA BOARD OF MASSAGE THERAPY MASSAGE ESTABLISHMENT CHANGE OF LOCATION/ NAME APPLICATION WITH INSTRUCTIONS Board of Massage Therapy 4052 Bald Cypress Way, #C-06 Tallahassee, FL 32399-3256 (850)

More information

JOB APPLICATION. We are an Equal Opportunity/Reasonable Accommodation Employer POSITION DESIRED PERSONAL DATA

JOB APPLICATION. We are an Equal Opportunity/Reasonable Accommodation Employer POSITION DESIRED PERSONAL DATA www.azmag.gov JOB APPLICATION We are an Equal Opportunity/Reasonable Accommodation Employer Do not change the format or layout of this form. After downloading the form, if you have any questions or problems,

More information

APPLICATION FOR ADDICTION COUNSELOR TRAINEE RECOGNITION OR ADDICTION COUNSELOR TRAINEE RENEWAL

APPLICATION FOR ADDICTION COUNSELOR TRAINEE RECOGNITION OR ADDICTION COUNSELOR TRAINEE RENEWAL Board of Addiction and Prevention Professionals (BAPP) 3101 West 41 st Street, Suite 205, Sioux Falls, SD 57105 Phone: 605-332-2645 Fax: 605-332-6778 Email: bapp@midconetwork.com Web: www.dss.sd.gov/bapp

More information

APPLICANTS OF FIRE FIGHTER/EMT

APPLICANTS OF FIRE FIGHTER/EMT APPLICANTS OF FIRE FIGHTER/EMT The documentation listed below must be completed, notarized, and stapled to the back of your employment application and returned to the Personnel Department. Applications

More information

CHAPTER 2011-71. Committee Substitute for Committee Substitute for Senate Bill No. 1316

CHAPTER 2011-71. Committee Substitute for Committee Substitute for Senate Bill No. 1316 CHAPTER 2011-71 Committee Substitute for Committee Substitute for Senate Bill No. 1316 An act relating to loan processing; amending s. 494.001, F.S.; creating and revising definitions; deleting a redundant

More information

Georgia Resident Application Questionnaire Initial Temp License or Permanent License

Georgia Resident Application Questionnaire Initial Temp License or Permanent License Georgia Resident Application Questionnaire Initial Temp License or Permanent License *Note this form should not be used for Temp Renewal or Temp to Permanent Licenses. Please use GID-103 Application (August

More information

Department of Health

Department of Health Department of Health Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling MARRIAGE AND FAMILY THERAPY DUAL LICENSURE APPLICATION Qualifications for Marriage and Family

More information

FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY APPLICATION FOR LIMITED LICENSURE DENTIST/DENTAL HYGIENIST

FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY APPLICATION FOR LIMITED LICENSURE DENTIST/DENTAL HYGIENIST Statute and Rule References: -Section 456.015, Florida Statutes -Rule 64B5-7.007, Florida Administrative Code APPLICATION FOR LIMITED LICENSURE DENTIST/DENTAL HYGIENIST General Requirements and Information

More information

DEPARTMENT OF HEALTH. APPLICATION FOR LIMITED LICENSURE and Instructions

DEPARTMENT OF HEALTH. APPLICATION FOR LIMITED LICENSURE and Instructions DEPARTMENT OF HEALTH BOARD OF CLINICAL SOCIAL WORK, MARRIAGE AND FAMILY THERAPY AND MENTAL HEALTH COUNSELING APPLICATION FOR LIMITED LICENSURE and Instructions APPLICATION FOR LIMITED LICENSURE INSTRUCTIONS

More information

Oral Health Project Manager (Dental Director) $2,961 to $4,013 monthly, commensurate with training and experience FTE 50%

Oral Health Project Manager (Dental Director) $2,961 to $4,013 monthly, commensurate with training and experience FTE 50% State of Hawaii Department of Health Family Health Services Division Manoa to Kahala, Oahu Oral Health Project Manager (Dental Director) $2,961 to $4,013 monthly, commensurate with training and experience

More information

AN EQUAL OPPORTUNITY EMPLOYMENT APPLICATION

AN EQUAL OPPORTUNITY EMPLOYMENT APPLICATION AN EQUAL OPPORTUNITY EMPLOYMENT APPLICATION Please Print Date: Name: Last First Middle Home Phone: Cell Phone: Social Security #: Present Email : No. Street City State Zip Mailing (If Different) No. Street

More information

GENERAL INFORMATION AND APPLICATION INSTRUCTIONS PLEASE READ THESE INSTRUCTIONS COMPLETELY BEFORE MAILING THE APPLICATION.

GENERAL INFORMATION AND APPLICATION INSTRUCTIONS PLEASE READ THESE INSTRUCTIONS COMPLETELY BEFORE MAILING THE APPLICATION. GENERAL INFORMATION AND APPLICATION INSTRUCTIONS PLEASE READ THESE INSTRUCTIONS COMPLETELY BEFORE MAILING THE APPLICATION. Any missing documents will slow the processing of your application. Any reference

More information

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney Shawnee County Courthouse Fax: (785) 251-4909 200 SE 7th Street, Suite 214 Family Law Fax: (785)

More information

Thank you for your interest in the Summer Nursing Intern Program at Johnson Memorial Health Services.

Thank you for your interest in the Summer Nursing Intern Program at Johnson Memorial Health Services. Name: Thank you for your interest in the Summer Nursing Intern Program at Johnson Memorial Health Services. Please complete the application packet. Interns must be enrolled in a summer internship course

More information

Assignments include the following:

Assignments include the following: UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF INDIAN EDUCATION Crow Creek/Lower Brule Line Office Flandreau Indian School 1132 N. Crescent Street Flandreau, SD 57028 VACANCY ANNOUNCEMENT POSITION

More information

DEADLINE DATES SUBMITTING YOUR APPLICATION DISCLAIMER FRANKFORD HOSPITAL SCHOOL OF NURSING APPLICATION FOR ADMISSION

DEADLINE DATES SUBMITTING YOUR APPLICATION DISCLAIMER FRANKFORD HOSPITAL SCHOOL OF NURSING APPLICATION FOR ADMISSION FRANKFORD HOSPITAL SCHOOL OF NURSING APPLICATION FOR ADMISSION 4918 Penn Street Philadelphia, PA 19124 Phone (215) 831-6740 x124 Fax (215) 831-6732 http://www.frankfordhospitals.org/nursing INSTRUCTIONS

More information

Selah Fire Department Yakima County Fire District # 2

Selah Fire Department Yakima County Fire District # 2 Volunteer Application Packet 2014 Web Application 206 West Fremont Avenue - Selah, Washington 98942 Chief Gary Hanna Business Phone (509) 698-7310 Fax (509) 698-7317 Volunteer Firefighter Thank you for

More information

Columbia College Police Department Howard M. Cook Chief 1301 Columbia College Drive Columbia, SC 29203

Columbia College Police Department Howard M. Cook Chief 1301 Columbia College Drive Columbia, SC 29203 Columbia College Police Department Howard M. Cook Chief 1301 Columbia College Drive Columbia, SC 29203 All Columbia College Police Department Applicants Pre-Employment Requirements Thank you for your interest

More information

STATE OF FLORIDA BOARD OF MASSAGE THERAPY APPLICATION FOR COLON HYDROTHERAPY UPGRADE TO MASSAGE THERAPIST LICENSE WITH INSTRUCTIONS

STATE OF FLORIDA BOARD OF MASSAGE THERAPY APPLICATION FOR COLON HYDROTHERAPY UPGRADE TO MASSAGE THERAPIST LICENSE WITH INSTRUCTIONS STATE OF FLORIDA BOARD OF MASSAGE THERAPY APPLICATION FOR COLON HYDROTHERAPY UPGRADE TO MASSAGE THERAPIST LICENSE WITH INSTRUCTIONS Board of Massage Therapy 4052 Bald Cypress Way, Bin # C-06 Tallahassee,

More information

CITY OF COEUR D'ALENE

CITY OF COEUR D'ALENE CITY OF COEUR D'ALENE HUMAN RESOURCES City Hall, 710 E. Mullan Avenue Cœur d Alene, Idaho 83816-3964 EXAM ANNOUNCEMENT FOR POLICE OFFICER Apply by August 15, 2014 for the September 8-12, 2014 Testing Process

More information

NOTICE TO ALL APPLICANTS FOR A PER DIEM JUDGE POSITION

NOTICE TO ALL APPLICANTS FOR A PER DIEM JUDGE POSITION NOTICE TO ALL APPLICANTS FOR A PER DIEM JUDGE POSITION FACTORS AFFECTING QUALIFICATION The Commission on Judicial Conduct has indicated in a formal opinion that any per diem judge and their partners/associates

More information

Please type or print clearly and return to the Internship Director. STUDENT NAME: College ID# DOB. Street. City State Zip Code CAMPUS EMAIL ADDRESS:

Please type or print clearly and return to the Internship Director. STUDENT NAME: College ID# DOB. Street. City State Zip Code CAMPUS EMAIL ADDRESS: CRIMINAL JUSTICE DEPARTMENT AT SAINT ANSELM COLLEGE Please type or print clearly and return to the Internship Director STUDENT NAME: _College ID# DOB PERMANENT HOME ADDRESS: Street City _State_Zip Code

More information

Agency Name: Fish and Wildlife Conservation Req No: 77000615-51254435-20131213120002 Commission Description: Working Title:

Agency Name: Fish and Wildlife Conservation Req No: 77000615-51254435-20131213120002 Commission Description: Working Title: Florida Fish and Wildlife Conservation Commission - Job Announcement EDUCATION SPECIALIST - FWC Req No: 77000615-51254435-20131213120002 Agency Name: Fish and Wildlife Conservation Commission Description:

More information

PRINCIPAL APPLICATION PACKET

PRINCIPAL APPLICATION PACKET Archdiocese of Mobile Office of Catholic Schools PRINCIPAL APPLICATION PACKET OFFICE OF CATHOLIC SCHOOLS Archdiocese of Mobile 352 Government Street, Mobile, AL 36602 251.438.4611 Dear Applicant: Thank

More information

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney

OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney OFFICE OF THE DISTRICT ATTORNEY Third Judicial District Of Kansas Chadwick J. Taylor, District Attorney Shawnee County Courthouse Fax: (785) 251-4909 200 SE 7th Street, Suite 214 Family Law Fax: (785)

More information