Certified Process Server APPLICANT CHECKLIST
|
|
- Adela Wilkerson
- 8 years ago
- Views:
Transcription
1 Certified Process Server APPLICANT CHECKLIST THE TWENTIETH JUDICIAL CIRCUIT OF FLORIDA The Twentieth Judicial Circuit Court is implementing a few changes to the requirements to qualify for certification. This will be required annually. 1. How To Obtain An Application a. You may obtain an application online at b. You may obtain an application at the Office of Court Innovations and Program Analysis 2000 Main Street, Suite 304, Fort Myers, FL c. You may pickup an application at the Lee County Sheriff s Office Human Resources Division Six Mile Cypress Parkway, Fort Myers, FL 2. $ CHECK or MONEY ORDER application fee, made payable to LCSO. CASH IS NOT ACCEPTED. 3. Proof of successful completion of an approved process server education class in Service of Non- Enforceable Judicial Process Training. Lorenzo Walker Institute of Technology 3702 Estey Avenue Naples, FL Voice (239) spectn@collier.k12.fl.us Southeastern Public Safety Institute St. Petersburg College P.O. Box St. Petersburg, FL Voice (727) Fax (727) Original bond in the amount of $5, with a surety company authorized to do business in this State bound onto the 20 th Judicial Circuit or Original Continuation Certificate, if renewed. 5. Valid FL Drivers License. 6. Social Security Card. 7. Agree to submit to a complete background check; including a criminal background history and drug screening. NOTE: You Must Sign and Notarize, All Documents in the Presence of a Lee County Sheriff s Office Human Resources Assistant. INCOMPLETE Application Packages will not be accepted without approval. You must Call to Schedule An Appointment (no walk-ins) Lee County Sheriff s Office Human Resources Division Six Mile Cypress Parkway, Fort Myers, FL, 33912, (239) Submit completed application Photo taken Fingerprinting Drug screening
2 THE TWENTIETH JUDICIAL CIRCUIT OF FLORIDA Certified Process Server APPLICATION PLEASE TYPE OR PRINT CLEARLY DATE SUBMITTED: NEW - OR- RENEWAL PERSONAL INFORMATION Full Name: Last First Middle Social Security Number: Sex: M F Date of Birth / _/ HOME ADDRESS Home Address (No Post Office Box): City State Zip Mailing Address, (if different): City State Zip Phone Number: ( ) Cell Phone: ( ) Address: EMPLOYER ADDRESS (PLEASE PROVIDE NAME OF SERVER AGENCY, IF APPLICABLE) Employer Name: Are you Self Employed?: Yes No Business Address (No Post Office Box): City State Zip Mailing Address, (if different): City State Zip Phone Number: ( ) Fax Number: ( ) Address / Website: PUBLIC ACCESS INFORMATION - FOR PUBLICATION ON CPSRB WEBSITE Name /Company: Mailing Address: City State Zip Phone Number: ( ) Fax Number: ( ) Address / Website What county(s) do you prefer to offer service? Charlotte Collier Glades Hendry Lee EMPLOYMENT HISTORY 1. Have you ever been employed by ANY Law Enforcement Agency? Yes No If yes, list the agency, address, phone number, position, and dates of employment.
3 Criminal History 1. Do you currently have any pending criminal actions? Yes No If YES, list the charge, agency, address, phone number, agency case number or court case number. 2. In the last 5 years, have you ever been convicted of a felony, including any convictions that may be sealed or expunged? Yes No If YES, detail the crime, disposition, and jurisdiction. If you have ever been convicted of any felony, please attach documentation showing civil rights restoration, if any. 3. In the last 5 years, have you ever been convicted of a misdemeanor, including any convictions that may be sealed or expunged? Yes No If YES, detail the crime, disposition, and jurisdiction. Are you presently on probation for any criminal offense? Yes No If YES, provide detail.
4 THE TWENTIETH JUDICIAL CIRCUIT OF FLORIDA I hereby affirm that this application is true and correct, and that all information provided for this appointment is true and correct. DATE: SIGNATURE OF APPLICANT NAME OF APPLICANT (PRINT) STATE OF FLORIDA COUNTY OF LEE Subscribed and sworn before me this day of, 20 by (Name of Applicant). He/She is personally know to me or has presented as identification. SIGNATURE OF NOTARY PRINTED NAME OF NOTARY Notary Public TITLE
5 Certified Process Server AGREEMENT THE TWENTIETH JUDICIAL CIRCUIT OF FLORIDA Effective January 1, 2011, all current Twentieth Judicial Circuit Certified Process Servers and all new Applicants for Certification as a Certified Process Server, in acceptance of their Certification acknowledges and agrees to the following rules, regulations, and conditions as set forth herein: 1. Shall pay a non-refundable annual application fee of $ Shall conform to an abide by the requirements of Florida Statutes, Chapter 48, as well as any other applicable laws, rules, and regulations that may apply. 3. Shall assert and consent that any Certification granted will be limited to the service of non-enforceable process and does not extend to enforceable process of any kind. 4. Upon Certification, a picture identification card with an expiration date will be issued by the Chief Judge of the Twentieth Judicial Circuit Court, which must be carried on your person at all times and displayed upon request while performing the duties of a Certified Process Server. If the identification card is lost, stolen, or misplaced, you shall report such loss in writing to the Twentieth Judicial Circuit Certified Process Server Review Board, hereinafter referred to as The Board, within 24 hours. The identification card is the property of the Twentieth Judicial Circuit Court and must be returned to The Board upon your departure. 5. Shall obtain a Bond in the amount of $5, with any Surety Company authorized to do business in the State of Florida. The Bond must be bound to the Twentieth Judicial Circuit Court and be effective from January 1 st through December 31 st for each year of your Certification. 6. Shall submit to a background investigation, which shall include but not be limited to, the review of any criminal record. 7. Shall submit to a drug test at the time of application and/or any sanctioned random drug testing program. 8. Shall charge only a reasonable fee for service. 9. Shall notify The Board in writing within 10 days of any change in mailing address, telephone number(s), address(s) or any other changes that affect your ability to be contacted. 10. Any Return or Affidavit of Service signed by you as the Process Server, knowing that the process was in fact served by someone else, will be considered a false Return or Affidavit of Service, punishable as provided for in Florida Statutes, Chapter Shall file a completed Return or Affidavit of Service pursuant to the requirements of Florida Statutes, Chapter 48.21, for every service that you make, but you must do so within the time frame during which the
6 person served must respond to the process. You must sign and print your name, along with your identification number, on each Return or Affidavit of Service. 12. All process served shall contain the date and time of service, your identification number and initials or signature, pursuant to Florida Statutes, Chapter (5). 13. If any signed complaints are received against you, you may be subject to Disciplinary Procedures as outlined in Administrative Order No. 1.11, or any superseding Orders. You have the right to participate in any disciplinary procedures as outlined in the Administrative Order. 14. Shall not serve any process in which you have an interest in the cause of action or are a direct employee of the law firm for whom the process is being served, and you shall not willfully or knowingly execute a false Return or Affidavit of Service, recognizing that a violation thereof may subject you to being charged with a third degree felony and permanently barred from serving process in the State of Florida, pursuant to Florida Statutes, Chapter 48.31(2). 15. Shall not violate the Oath of Office nor simulate or circulate process as prohibited by Florida Statutes, Chapter Shall hold harmless and indemnify the Twentieth Judicial Circuit Certified Process Server Review Board and its Members, the Twentieth Judicial Circuit Court and its Chief Judge, agents, appointees, and employees against any claims or judgments of any kind or nature whatsoever that may arise from or could be caused by any act or failure to act on your part. 17. Shall recognize that you represent the Twentieth Judicial Circuit Court and its Chief Judge, and you shall be courteous and professional while serving process. You shall not engage in any conduct, whether or not connected to the performance of your official duties, that may reflect negatively on the Twentieth Judicial Circuit Court or its Chief Judge. 18. Shall be familiar with the provisions of Florida Statutes, Chapter , prohibiting the use of certain lights, and Florida Statutes, Chapter , regulating the unlawful use of police badges or other indicia of authority. Your Certified Process Server identification card, while shown for identification purposes in the performance of your official duties, is exempt from this provision. 19. Shall attend a sanctioned 40-Hour Non-Enforceable Judicial Process Server Course, and a sanctioned 4-Hour Non-Enforceable Judicial Process Server Refresher Course annually thereafter, at your expense, and submit to a written examination testing your knowledge of the laws and rules regarding the service of process, with a passing grade of 70% or better. Failure to complete these courses with a passing grade of 70% or better will result in the denial of your Certification or renewal of Certification. 20. Shall notify The Board in writing within 72 hours or any arrest, and within 72 hours of the disposition thereof. You shall also notify The Board in writing within 72 hours of any civil lawsuit served upon you involving the performance of your official duties, and within 72 hours of the disposition thereof. 21. Shall notify The Board in writing within 24 hours of any conflict or dispute that required the involvement of a law enforcement officer while in the performance of your official duties.
7 22. Shall maintain a valid Florida Driver s License at all times. 23. All applications for Certification or renewal of Certification shall be submitted, between September 1 st through October 30 th of each year. If October 30 th falls on a non-business day, then the submittal day will be extended to the next business day. If an application for Certification or renewal of Certification is not submitted during this timeframe, the application will not be accepted. I understand and agree that this CERTIFIED PROCESS SERVER AGREEMENT is to be submitted, signed, and notarized, with my application and will become a permanent part of my application and file. DATE: SIGNATURE OF APPLICANT NAME OF APPLICANT (PRINT) STATE OF FLORIDA COUNTY OF LEE Subscribed and sworn before me this day of, 20 by (Name of Applicant). He/She is personally know to me or has presented as identification. SIGNATURE OF NOTARY PRINTED NAME OF NOTARY Notary Public TITLE
PROCESS SERVER CERTIFICATION CHECKLIST. Signed and Dated Application for certified process server. Signed and Notarized Release of information
PROCESS SERVER CERTIFICATION CHECKLIST Enclosed please find a copy of Amended Administrative Order 02-08 and an application packet. The completed application packet and all items on the checklist are to
More informationINSTRUCTIONS FOR SEALING/EXPUNGING AN ADULT CRIMINAL COURT RECORD
INSTRUCTIONS FOR SEALING/EXPUNGING AN ADULT CRIMINAL COURT RECORD Complete the following paperwork for this process: Step 1. Florida Department of Law Enforcement (FDLE) Certificate of Eligibility packet
More informationTOM GREEN COUNTY BAIL BOND INDIVIDUAL SURETY LICENSE APPLICATION
New Application Renewal Application TOM GREEN COUNTY BAIL BOND INDIVIDUAL SURETY LICENSE APPLICATION **Submit Original & 14 Copies with filing fee to Tom Green County Treasurer** NO APPLICATION SHALL BE
More information-410 St John s Avenue, Palatka, FL or from the following website http://.putnam-fl.com/coc/
INSTRUCTIONS FOR FILING A PETITION TO SEAL OR EXPUNGE CRIMINAL RECORDS 1. Before you can file your petition to expunge or seal your criminal history record with the court, you must apply to the Florida
More informationASSOCIATED LICENSEE LOAN MODIFICATION CONSULTANT, FORECLOSURE CONSULTANT AND COVERED SERVICE PROVIDER APPLICATION FOR RENEWAL OF LICENSE AND CHECKLIST
STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY DIVISION OF MORTGAGE LENDING 1830 College Parkway, Suite 100 Carson City, NV 89706 (775) 684-7060 Fax (775) 684-7061 www.mld.nv.gov ASSOCIATED LICENSEE
More informationJudicial Council of Georgia
Form 1 Judicial Council of Georgia CERTIFIED PROCESS SERVER APPLICATION 1. Name (Last Name) (First Name) (Middle Initial) 2. Address City State ZIP 3. Work Telephone ( ) 4. Alternate Telephone ( ) 5. of
More informationCLASS A LICENSE RENEWAL APPLICATION
- BINGO - INSTRUCTIONS CLASS A LICENSE RENEWAL APPLICATION Pinellas County Code, Chapter 10 requires charitable organizations and authorized organizations holding a Class A Bingo License to apply to renew
More informationDEPARTMENT 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 informationKentucky Motor Vehicle Commission SALESPERSON LICENSE APPLICATION IMPORTANT NOTICE REGARDING ALL SALES PERSONNEL
IMPORTANT NOTICE REGARDING ALL SALES PERSONNEL All persons employed by a dealership in a sales capacity, even if on a temporary basis, and those individuals identified in 605 KAR 1:050 Section 5 must be
More informationApplication for Registration or Renewal of Athlete Agent
11 F0091 OFFICE OF THE MISSISSIPPI SECRETARY OF STATE Post Office Box 136, Jackson, MS 39205-0136 (601)359-9055 Application for Registration or Renewal of Athlete Agent A Certificate of Registration or
More informationGEORGIA BOARD OF PHARMACY 2 Peachtree Street, N.W. 36 th Floor Atlanta, Georgia 30303
GEORGIA BOARD OF PHARMACY 2 Peachtree Street, N.W. 36 th Floor Atlanta, Georgia 30303 PHARMACY TECHNICIAN INFORMATION SHEET AND CHECKLIST In accordance with O.C.G.A. 26-4-28, the Georgia Board of Pharmacy
More informationORDER GOVERNING CERTIFIED PROCESS SERVER PROGRAM, NINTH JUDICIAL CIRCUIT
ADMINISTRATIVE ORDER NO. 2014-27 IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT, IN AND FOR ORANGE AND OSCEOLA COUNTIES, FLORIDA ORDER GOVERNING CERTIFIED PROCESS SERVER PROGRAM, NINTH JUDICIAL CIRCUIT
More informationSolicitor Permit Application
Solicitor Permit Application The City of Dunwoody has established the following application to allow for registration of persons, firms, or corporations to engage in the business of soliciting or calling
More informationInstructions for Sealing a Criminal Record. (Expungement)
Instructions for Sealing a Criminal Record (Expungement) TABLE OF CONTENTS What is Expungement/Sealing of Record?... 1 Why Get an Expungement?...1 Who Can Use This Packet?...1 Can I Get My Record Expunged?...2
More informationInstructions for Pistol Permit Applicants. If you have any questions call 845 291-7942
Instructions for Pistol Permit Applicants. If you have any questions call 845 291-7942 Description of forms in this Packet: Form PPS-19: This form is a checklist of all the documents you will need to provide
More information2015-2016 Hillsborough County Pain Management Clinic Licensing Important Information
2015-2016 Hillsborough County Pain Management Clinic Licensing Important Information All pain management clinics currently licensed by Hillsborough County must apply for a 2015-2016 license prior to October
More informationINSTRUCTIONS FOR COMPLETING DBPR ABT 6021 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR PASSENGER VESSEL PERMIT
INSTRUCTIONS FOR COMPLETING DBPR ABT 6021 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR PASSENGER VESSEL PERMIT If you have any questions or need assistance in completing this application,
More informationCORPORATE SURETY LICENSE APPLICATION
CORPORATE SURETY LICENSE APPLICATION WILLIAMSON COUNTY BAIL BOND BOARD WILLIAMSON COUNTY DISTRICT ATTORNEY S OFFICE GEORGETOWN, TEXAS New Application Renewal Application NO APPLICATION SHALL BE DEEMED
More informationHempfield Township Board of Supervisors
Hempfield Township Board of Supervisors 05/05/2015 MASSAGE THERAPIST APPLICATION Attach the following items at the time of application and renewal. Incomplete applications will not be processed or accepted.
More informationINSTRUCTIONS PETITION FOR EXPUNGEMENT OF CRIMINAL RECORDS PROVIDED UNDER W.VA. CODE 61-11-26
INSTRUCTIONS PETITION FOR EXPUNGEMENT OF CRIMINAL RECORDS PROVIDED UNDER W.VA. CODE 61-11-26 Petition Form Carefully read the attached form to fill out your Petition for Expungement of Criminal Records
More informationFORMS AND INSTRUCTIONS CAN ALSO BE PRINTED DROM THE CLERK OF COURTS WEBSITE AT: www.duvalclerk.com
TO OBTAIN SEALING/EXPUNGING CERTIFICATION PACKAGES, TO REVIEW FREQUENTLY ASKED QUESTIONS, AND FOR CONTACT INFORMATION PLEASE GOTO THE FDLE WEBSITE AT: www.fdle.state.fl.us/expunge/ FORMS AND INSTRUCTIONS
More informationHOW TO FILE A PETITION TO EXPUNGE JUVENILE OFFENSES
HOW TO FILE A PETITION TO EXPUNGE JUVENILE OFFENSES Disclaimer Neither the staff in Court Administration nor the staff in any Court office will be able to give you legal advice or help you fill out/complete
More informationJEFFERSON COUNTY BAIL BOND BOARD APPLICATION FOR SURETY LICENSE
JEFFERSON COUNTY BAIL BOND BOARD APPLICATION FOR SURETY LICENSE NOTICE: Pursuant to Occupations Code Chapter 1704.162 Section (2) (b) and the Jefferson County Bail Bond Board local rules, failure to submit
More informationFLORIDA 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 informationINSTRUCTIONS 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 informationNote: 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 information3. The Check Writer must NOT have asked the acceptor to HOLD or DELAY DEPOSIT of the check, even for a very brief period of time.
Procedures and Requirements for filing a Worthless Check Complaint with the Office of the State Attorney s Office, Broward County, Florida Phone 954-831-8444 1. The check must have been accepted in Broward
More informationMississippi State Board of Nursing Home Administrators 1755 Lelia Drive, Ste. 305, Jackson, MS 39216 (601) 362-6914 www.msnha.ms.
1755 Lelia Drive, Ste. 305, Jackson, MS 39216 (601) 362-6914 www.msnha.ms.gov Application Information Sheet Administrator-in-Training Program (AIT) It is reasonable for you to expect a time frame of nine
More informationQuincy Police Department One Sea Street Quincy, MA 02169 (617) 479-1212 TTY: (617) 376-1375
PAUL KEENAN CHIEF OF POLICE Quincy Police Department One Sea Street Quincy, MA 02169 (617) 479-1212 TTY: (617) 376-1375 Please complete the attached Firearms Application. All questions must be answered
More informationPrivate Protective Services - Contract Security Company Application, Page 1
Private Protective Services - Contract Security Company Application, Page 1 STATE OF TENNESSEE DEPARTMENT OF COMMERCE & INSURANCE DIVISION OF REGULATORY BOARDS PRIVATE PROTECTIVE SERVICES 500 JAMES ROBERTSON
More informationNOTICE TO GRANDPARENT
A Power of Atrney may be created if the parent, guardian, or cusdian of the child is any of the following: 1. Seriously ill, incarcerated, or about be incarcerated 2. Temporarily unable provide financial
More informationEASTERN FLORIDA STATE COLLEGE PUBLIC SAFETY INSTITUTE
EASTERN FLORIDA STATE COLLEGE PUBLIC SAFETY INSTITUTE Application for the 911 Public Safety TelecommunicatorAcademy RETURN THIS ENTIRE APPLICATION AND ALL REQUESTED SUPPORTING DOCUMENTATION IN PERSON OR
More informationSTEP 5 - EDUCATION You must request Official Transcripts verifying your education, to be sent directly from your college or university.
INFORMATION & INTRUCTIONS FOR CPA CERTIFICATION This application is for CPA Licensure by Original Certification based on an applicant s passing the CPA Examination in another state. The applicant will
More informationAPPLICATION FOR A TEACHER S LICENSE - DENTISTRY OR DENTAL HYGIENE
Maryland State Board of Dental Examiners Spring Grove Hospital Center Benjamin Rush Building 55 Wade Avenue Catonsville, Maryland 21228 (410) 402-8510 APPLICATION FOR A TEACHER S LICENSE - DENTISTRY OR
More informationHow to Clear an Arrest from Your Record in Texas (Expunction)
How to Clear an Arrest from Your Record in Texas (Expunction) Can I clear an arrest from my record? You may be able to clear an arrest from your record through a process called expunction if: charges were
More informationINSTRUCTIONS FOR COMPLETING DBPR ABT 6006 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR CIGAR WHOLESALE DEALER PERMIT
INSTRUCTIONS FOR COMPLETING DBPR ABT 6006 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR CIGAR WHOLESALE DEALER PERMIT If you have any questions or need assistance in completing this application,
More informationApplication for License as Home Inspector passport sized color photographs of head and shoulders. Photos must be of
Attach with paper clip two (2) Application for License as Home Inspector passport sized color photographs of head and shoulders. Photos must be of LA. STATE BOARD OF HOME INSPECTORS passport quality. Print
More informationALL LOAN BROKERS AND ORIGINATORS DOING BUSINESS IN INDIANA FROM: OFFICE OF SECRETARY OF STATE TODD ROKITA, SECURITIES DIVISION
MEMORANDUM TO: ALL LOAN BROKERS AND ORIGINATORS DOING BUSINESS IN INDIANA FROM: OFFICE OF SECRETARY OF STATE TODD ROKITA, SECURITIES DIVISION RE: LICENSING AND REGISTRATION REQUIREMENTS FOR LOAN BROKERS
More informationPRIVATE INVESTIGATOR APPLICANT INSTRUCTIONS
COMMONWEALTH OF KENTUCKY KENTUCKY BOARD OF LICENSURE FOR PRIVATE INVESTIGATORS PO BOX 1360 FRANKFORT KY 40602-1360 (502) 564-3296, ext. 223 (502) 564-4818 FAX PRIVATE INVESTIGATOR APPLICANT INSTRUCTIONS
More informationCLASS B LIMOUSINE CARRIER CERTIFICATE
GEORGIA DEPARTMENT OF PUBLIC SAFETY MCCD REGULATIONS COMPLIANCE P.O. BOX 1456 ATLANTA, GEORGIA 30371 (404) 624-7244 OR (404) 624-7243 FAX: (404) 624-7246 www.gamccd.net APPLICATION FOR CLASS B LIMOUSINE
More informationTexas Department of Insurance Individual Insurance License Application
Texas Department of Insurance Individual Insurance License Application This application is only for applicants who must take or have taken a Prometric examination and applicants for a temporary license.
More informationSouth Carolina Department of Insurance Professional Bondsman / Runner / Surety Bondsman License Application
South Carolina Department of Insurance Professional Bondsman / Runner / Surety Bondsman License Application Staple a passport size full-face photograph of applicant here. Please check only one type of
More informationCity of Terrell Hills 5100 North New Braunfels Avenue San Antonio, Texas 78209 210-824-7401
To All Applicants: In order for the City of Terrell Hills to process this application, it must be complete. All lines must be filled in. If something does not apply to you, then write N/A in that blank.
More informationConstruction Trades Qualifying Board APPLICATION FOR BUSINESS CERTIFICATION OR ADDING D/B/A TO EXISTING BUSINESS LICENSE
Construction Trades Qualifying Board APPLICATION FOR BUSINESS CERTIFICATION OR ADDING D/B/A TO EXISTING BUSINESS LICENSE BUSINESS APPLICATION INCLUDING D/B/A... $ 315.00 (Business Application not applicable
More informationCriminal 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 informationBROKER LICENSE INDIVIDUAL REQUIREMENTS. The following are the basic requirements an applicant must satisfy to obtain a broker license:
COMMONWEALTH OF PENNSYLVANIA INSURANCE DEPARTMENT BUREAU OF PRODUCER LICENSING 1300 Strawberry Square Phone (717) 787-3840 Harrisburg, PA 17120 Fax (717) 787-8553 BROKER LICENSE INDIVIDUAL REQUIREMENTS
More informationAPPLICATION FOR REGISTERED NURSE BY ENDORSEMENT
THE STATE of ALASKA Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing Board of Nursing 550 West 7 th Avenue, Suite 1500 Anchorage,
More informationCHARTER SIGHTSEEING LICENSE APPLICATION
Rahm Emanuel Mayor City of Chicago Department of Business Affairs and Consumer Protection Public Vehicle Operations Division 2350 West Ogden Avenue, 1st Floor Chicago, Illinois 60608 (312) 746-4200 (312)
More informationOFFICE 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 informationNOTICE 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 informationNEW/RENEWAL APPLICATION FOR PAIN MANAGEMENT CLINIC REGISTRATION
Department of Regulatory and Economic Resources Business Affairs Division Office of Consumer Protection 601 NW 1st Court, 18th Floor Miami, Florida 33136 Tel: 786-469-2300 Fax: 786-469-2311 email: license@miamidade.gov
More informationMONTANA BOARD OF PUBLIC ACCOUNTANTS
MONTANA BOARD OF PUBLIC ACCOUNTANTS 301 South Park 4 th Floor PO Box 200513 Helena Mt 59620 0513 Phone: 406 841 2203 E mail: dlibsdpac@mt.gov Website: www.publicaccountant.mt.gov APPLICATION FOR ORIGINAL
More informationFINANCIAL CASUALTY & SURETY, INC. ALLIANCE SURETY SERVICES PO Box 393, Greenville, SC 29602 \ Phone 864-232-4567 Fax 864-232-4467
FINANCIAL CASUALTY & SURETY, INC. ALLIANCE SURETY SERVICES PO Box 393, Greenville, SC 29602 \ Phone 864-232-4567 Fax 864-232-4467 APPLICATION FOR LIABLE BAIL Agency / Producer fcs The BAIL Insurance Company
More informationPLEASE READ BEFORE COMPLETING APPLICATION
PLEASE READ BEFORE COMPLETING APPLICATION Information for Licensure: SOCIAL WORKER (LSW) Each item on the enclosed application must be completed. Allow 30 days for processing of the application. Failure
More informationGrandparent s Power of Attorney Information and Forms
NOTICE AND DISCLAIMER Grandparent s Power of Attorney Information and Forms The forms in this packet have been provided to you as a public service by the Butler County Juvenile Court. Although you may
More informationName: 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 informationGEORGIA DEPARTMENT OF PUBLIC SAFETY MCCD, REGULATIONS COMPLIANCE P.O. Box 1456 ATLANTA, GEORGIA 30371 (404) 624-7244 OR (404) 624-7243 www.gamccd.
GEORGIA DEPARTMENT OF PUBLIC SAFETY MCCD, REGULATIONS COMPLIANCE P.O. Box 1456 ATLANTA, GEORGIA 30371 (404) 624-7244 OR (404) 624-7243 www.gamccd.net APPLICATION FOR A PASSENGER PERMIT (CHARTER OPERATIONS)
More informationAPPLICATION FOR BAIL BOND LICENSE. 1. Name of Applicant: Age:
APPLICATION FOR BAIL BOND LICENSE Received Application on: By: Company Name License # 1. Name of Applicant: Age: Other Names Used (Alias, Maiden, Married) List All Driver s License # s and the State(s)
More informationINFORMATION FOR ASBESTOS HANDLING LICENSE APPLICANTS
STATE OF NEW YORK > DEPARTMENT OF LABOR DIVISION OF SAFETY AND HEALTH LICENSE AND CERTIFICATE UNIT BUILDING 12, ROOM 161 STATE CAMPUS ALBANY, NY 12240 (518) 457>2735 GENERAL INFORMATION INFORMATION FOR
More informationBUREAU OF INSURANCE STATE CORPORATION COMMISSION P.O. BOX 1157 RICHMOND, VA 23218
BUREAU OF INSURANCE STATE CORPORATION COMMISSION P.O. BOX 1157 RICHMOND, VA 23218 INSTRUCTIONS FOR COMPLETING THE INITIAL REINSURANCE INTERMEDIARY LICENSE APPLICATION GENERAL l. All responses except for
More informationRestoration of Civil Rights
Restoration of Civil Rights Application for More Serious Offenses PLEASE READ CAREFULLY: Persons who have been convicted of a violent offense, an offense against a minor, or an election law offense must
More informationBAIL BOND LICENSE APPLICATION FOR CORPORATE SURETY OF:
BAIL BOND LICENSE APPLICATION FOR CORPORATE SURETY OF: DATE SUBMITTED: FOR CONSIDERATION BY THE DALLAS COUNTY BAIL BOND BOARD ** please provide one original and one redacted copy ** DALLAS COUNTY BAIL
More informationPOWER OF ATTORNEY., the parent(s), the undersigned, residing at, in the county of, state of, hereby appoint the child s
POWER OF ATTORNEY Case No. I/we,, the parent(s) of, the undersigned, residing at, in the county of, state of, hereby appoint the child s grandparent,, residing at, in the state of Ohio, with whom the child
More informationAPPLICATION FOR CERTIFIED NURSE AIDE BY EXAMINATION
THE STATE of ALASKA Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing Nurse Aide Registry 550 West 7 th Avenue, Suite 1500 Anchorage,
More informationPLEASE REMOVE THIS PAGE BEFORE SUBMITTING APPLICATION.
August 18, 2014 Admission to Nursing Program, GENERIC OPTION January 2015 Dear Potential Applicant: This letter contains vital information and instructions that you must implement completely in order to
More informationJon A. Gegenheimer JEFFERSON PARISH CLERK OF COURT. 1 st Parish Court 924 David Dr. Metairie LA 70003 (504) 736-8910
Jon A. Gegenheimer JEFFERSON PARISH CLERK OF COURT 1 st Parish Court 924 David Dr. Metairie LA 70003 (504) 736-8910 CRIMINAL RECORD EXPUNGEMENT PROCEDURE INSTRUCTIONS & FEES 1. Provide cash or two cashier
More informationFiling Fee $117.00. Instructions for Sealing a Criminal Record
Filing Fee $117.00 Instructions for Sealing a Criminal Record Effective 1-1-2015 This packet is to be used to assist you in filing an application to seal your criminal record. * * * * * * * * * * * * *
More informationAPPLICATION FOR REINSTATEMENT OF NURSE AIDE CERTIFICATION
THE STATE of ALASKA Department of Commerce, Community, and Economic Development Nurse Aide Registry 550 West 7 th Avenue, Suite 1500 Anchorage, AK 99501 Phone: (907) 269-8169 Fax: (907) 269-8196 Email:
More informationSALE OF CHECKS,TRANSMISSION OF MONEY LICENSE APPLICATION (Chapter 23, Title 5, Del.C.)
FOR OFFICE USE ONLY: Inv. Fee: Check No: Receipt No: STATE OF DELAWARE OFFICE OF THE STATE BANK COMMISSIONER 555 EAST LOOCKERMAN STREET SUITE 210 DOVER, DELAWARE 19901 SALE OF CHECKS,TRANSMISSION OF MONEY
More informationLICENSING PROCEDURES FOR VIATICAL SETTLEMENT BROKERS AND PROVIDERS
Fax: (615) 532-2862 STATE OF TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE Insurance Division Agent Licensing 500 James Robertson Parkway Nashville, TN 37243-1134 615 741-2693 ce.agent.licensing@tn.gov
More informationPHARMACY TECHNICIAN APPLICATION & INSTRUCTIONS
PHARMACY TECHNICIAN APPLICATION & INSTRUCTIONS IMPORTANT INFORMATION: Complete this application if you are applying to the Board for a pharmacy technician registration. You must answer all questions on
More informationGrandparent Power of Attorney (POA) Checklist
Grandparent Power of Attorney (POA) Checklist Check off all statements which are true. If any statement is not true, do not check the statement. The POA cannot be filed unless all statements are checked
More informationGENERAL 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 informationAPPLICATION 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 informationPedicab and Neighborhood Electric Vehicle (NEV) Certificate of Operation Application Guide
Pedicab and Neighborhood Electric Vehicle (NEV) Certificate of Operation Application Guide INSTRUCTIONS 1. Fill out application completely. Incomplete applications cannot be processed. 2. The application
More information2. Present residence address no. street town state zip code. Mailing address, only if mail delivery is not available to residence address
Form # A-1 (Rev. 11/12/09) Notary Public Unit Office of the Secretary of the State State of Connecticut PO Box 150470 Hartford, CT 06115-0470 FOR OFFICE USE ONLY Trans. # Acct. # Date of Appt. APPLICATION
More informationARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY APPLICATION
ARKANSAS STATE POLICE SECURITY OR INVESTIGATION COMPANY APPLICATION FOR OFFICE USE ONLY EFFECTIVE 8-2015 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public record
More informationDIVISION 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 informationDepartment of Public Safety WRECKER SERVICES DIVISION General Requirements Applying for a Wrecker Service License
Department of Public Safety General Requirements Applying for a Wrecker Service License 1. An individual or company must have a wrecker vehicle as defined in the statues in Title 47 Section 951. Place
More informationElectrical, Plumbing, Home Appliance Repair & (Electronics) Suffolk County License Application
Steven Bellone Suffolk County Executive Frank Nardelli Commissioner SUFFOLK COUNTY DEPARTMENT OF LABOR, LICENSING & CONSUMER AFFAIRS P.O. Box 6100, Hauppauge, NY 11788-0099 (631) 853-4600 FAX (631) 853-4825
More informationCERTIFICATE OF SEALING
CERTIFICATE OF SEALING Before the Illinois Prisoner Review Board: The Certificate for Sealing Eligibility Acknowledgement form must be completed prior to filling out the application to determine eligibility.
More informationGENERAL INFORMATION AND APPLICATION INSTRUCTIONS
GENERAL INFORMATION AND APPLICATION INSTRUCTIONS General Radiographer Nuclear Medicine Technologist Radiation Therapy Technologist Computed Tomography Mammography Magnetic Resonance Imaging Radiologist
More informationCODE ENFORCEMENT BOARD CITY OR ORLANDO REQUEST FOR REDUCTION OF PENALTY
CODE ENFORCEMENT BOARD CITY OR ORLANDO CEB CASE NO. REQUEST FOR REDUCTION OF PENALTY By completing this form, you are making statements under oath. Failure to be truthful is a violation of Orlando City
More informationState of Oklahoma COUNCIL ON LAW ENFORCEMENT EDUCATION AND TRAINING Private Security Licensing Division
State of Oklahoma COUNCIL ON LAW ENFORCEMENT EDUCATION AND TRAINING Private Security Licensing Division CLEET Private Security Division Ada, Oklahoma 74820-0669 (405) 239-5100 Dear Agency Applicant: Thank
More informationSTATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS
STATE OF KANSAS OFFICE OF THE ATTORNEY GENERAL Through the KANSAS BUREAU OF INVESTIGATION INSTRUCTIONS RENEWAL OF PRIVATE DETECTIVE LICENSE *Complete this renewal form if you are an employee, owner, partner,
More informationAPPLICATION FOR DUI COURT
IN THE COURT OF COMMON PLEAS OF CENTRE COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA OTN # v CP-14-CR- - (name of applicant) APPLICATION FOR DUI COURT the District Attorney of Centre County I,, defendant
More informationLICENSING PROCEDURES FOR MANAGING GENERAL AGENTS TO OBTAIN AUTHORITY IN VIRGINIA
LICENSING PROCEDURES FOR MANAGING GENERAL AGENTS TO OBTAIN AUTHORITY IN VIRGINIA October 2005 GENERAL INFORMATION The 1992 Virginia General Assembly passed legislation requiring the licensing of managing
More informationCounty of Santa Clara Office of the District Attorney
County of Santa Clara Office of the District Attorney TO: PROSPECTIVE NEW EMPLOYEES AND VOLUNTEERS OF THE OFFICE OF THE DISTRICT ATTORNEY SUBJECT: BACKGROUND AND RECORD CHECK Jeffrey F. Rosen District
More informationFederal & State Criminal Background Check. Consent to Fingerprint Background Check
Federal & State Criminal Background Check Superior School District #3 (SSD3) requires that a national & state criminal history background check, including fingerprinting, be completed for all candidates
More informationLICENSING AT A LOWER LEVEL
EMS-APP-500 (11/2014) Michigan Department of Community Health Lansing, Michigan 48909 Website: www.michigan.gov/ems Authority: P.A. 368 of 1978, as amended This form is for information only. MICHIGAN COURSE
More informationHuron County Juvenile Court
Huron County Juvenile Court Instructions for: CHILD CARE POWER OF ATTORNEY AND CARETAKER AUTHORIZATION AFFIDAVIT This packet was prepared for your convenience and ease in filing a child care power of attorney
More information30 Day Limited Permits for Professional Engineers and Land Surveyors
THE STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234 Office of the Professions, State Board for Engineering and Land Surveying PHONE: 518-474-3817 ext. 140 FAX: 518-473-6282
More informationACCELERATED REHABILITATIVE DISPOSITION APPLICATION
OFFICE OF THE WARREN COUNTY DISTRICT ATTORNEY WARREN COUNTY COURT HOUSE 204 Fourth Avenue WARREN, PENNSYLVANIA 16365 Phone 814-728-3460 FAX 814-728-3483 ACCELERATED REHABILITATIVE DISPOSITION APPLICATION
More informationHOW TO OBTAIN A NEW CONTRACTOR LICENSE
HOW TO OBTAIN A NEW CONTRACTOR LICENSE These instructions apply to new licenses only. If you wish to add a classification or a qualifying party to an existing license, please see HOW TO ADD A CLASSIFICATION
More informationTECHNICIAN-IN-TRAING IS NOT PERMITTED TO PRACTICE IN MONTANA IN ANY MANNER WITHOUT AN ACTIVE MONTANA REGISTRATION
Page 1 of 8 MONTANA BOARD OF PHARMACY (301 S PARK, 4 TH FLOOR, HELENA, MT 59601 - Delivery) P. O. Box 200513 Helena, Montana 59620-0513 PHONE (406) 841-2300 FAX (406) 841-2344 E-MAIL: dlibsdpha@mt.gov
More informationRHODE ISLAND DEPARTMENT OF LABOR AND TRAINING DIVISION OF WORKFORCE REGULATION AND SAFETY PROFESSIONAL REGULTION UNIT
RHODE ISLAND DEPARTMENT OF LABOR AND TRAINING DIVISION OF WORKFORCE REGULATION AND SAFETY PROFESSIONAL REGULTION UNIT NEW ALARM BUSNIESS LICENSE REQUIERMENTS: Application for Alarm Business License must
More informationAuthorization to Attend. Law Enforcement/Corrections Academy
TO ALL AGENCIES: Agencies have several methods of sending a recruit to the basic recruit program here at Palm Beach State College. The first way is to sponsor the recruit. A sponsored recruit is one in
More informationProposed Method of Payment: Self Pay VA Assistance Financial Aid Bright Futures Florida Prepaid Paid Agency Sponsor/Agency Name:
Recruit Application Applicant Name: Street Address: Daytime telephone: Cell phone: E-Mail : @ Sex: Race: Social Security #: BAT Score: Desired Class: Law Enforcement Basic Recruit Program (Day Class) Law
More informationPACKET 9. Forms for a Petition for Temporary Custody When:
PACKET 9 Forms for a Petition for Temporary Custody When: 1. You are Extended Family or you reasonably believe that you are the father of the Minor Child(ren) 2. The child(ren) reside with you. EIGHTH
More informationThe Illinois Law Enforcement Intern Training Program Application for Admission
The Illinois Law Enforcement Intern Training Program Application for Admission Instructions for completion of application: 1. Please print or type in black ink. 2. Do not leave any question blank. If the
More information