Medical College of Georgia Applicant Criminal Record Check
|
|
|
- Andrew Jackson
- 9 years ago
- Views:
Transcription
1 CITATION REFERENCE Official Title: Medical College of Georgia Applicant Criminal Record Check Abbreviated Title: Applicant Criminal Record Check Volume: Medical College of Georgia Responsible Office: Admissions Originally issued: June 2009 Georgia Regents University Administrative Policy Library Medical College of Georgia Applicant Criminal Record Check Policy Statement The Georgia Regents University (GRU) will conduct Criminal record checks on all applicants accepted for admission to the Medical College of Georgia. Reason For Policy The Association of American Medical Colleges (AAMC) recommends that all U.S. medical schools obtain a national records check on applicants upon their initial, conditional acceptance to medical school. In recognition of this recommendation, the AAMC has initiated an AMCAS facilitated national records check service. 1 The purposes of conducting criminal record checks are multiple: To assure the public s continuing trust in the medical profession regarding the safety and well-being of patients. To identify accepted applicants who have a criminal history that may preclude them from participating in the clinical training programs, including but not limited to, care of patients in vulnerable populations. To assure compliance with various regulatory or accrediting agencies that require or recommend such checks. To put applicants with a criminal history on notice that there may be an issue with respective licensing boards regarding the impact of the criminal history on their ability to obtain professional licensure. Entities Affected By This Policy This policy applies to all persons seeking admission to the GRU Medical College of Georgia. Who Should Read This PolicyAll persons interested in GRU Medical College of Georgia admissions processes, all Medical College of Georgia employees and all Medical College of Georgia administrators should read this policy.
2 1 AAMC website at: Contacts Contact Phone /url Admissions Office Office of LegalAffairs Website Address For This Policy Related Documents Definitions These definitions apply to these terms as they are used in this policy: Conditional Acceptance The admissions status of an applicant who is admitted to the GRU Medical College of Georgia subject to the successful completion and review of a criminal record check as determined by the Criminal History Review Committee. Criminal Record Check A review of a conditionally accepted applicant s criminal record. Criminal History Review Committee (CHRC) The administrative committee charged with reviewing a conditionally accepted applicant s criminal record and determining whether the candidate will be granted final acceptance. Statement of Policy Criminal record checks will be conducted on all applicants accepted for admission to the Medical College of Georgia at GRU. Process/Procedures (1) Authorization Process and the Criminal Record Check (a) Upon initial, conditional acceptance to the Medical College of Georgia at GRU, the AAMC selected vendor will send an notification to the applicant to obtain consent for the criminal record report to be procured. In addition, the Medical College of Georgia may request that the AAMC selected vendor send to the alternate list applicants an notification to obtain consent for the criminal record report to be procured. If a report is procured prior to conditional acceptance to the Medical College of Georgia at GRU, the report will not be made available to the Medical College of Georgia until the AAMC receives notice of the applicant s conditional acceptance. (b) Once consent has been provided, the AAMC selected vendor will conduct a records check and produce a report. The records check will only report convictions, conviction equivalent adjudications 2, and all arrests without Conviction and Conviction-Equivalent Adjudications may include, but are not limited to, the following criminal records dispositions: Alford plea, bail/bond forfeiture, default judgment, fine/costs paid, guilty, no contest, plea in absentia, plea in abeyance, pled guilty, prayer for judgment, suspended execution of sentence, appealed, consolidated for judgment, covered by
3 final adjudication 3 (both felonies and misdemeanors). When the report is complete, the AAMC select vendor will send an to the conditionally accepted applicant requesting that he/she review the report prior to its distribution. Upon receiving this , the accepted applicant will have ten calendar days from the date the is sent to review their report prior to the report being made available to Medical College of Georgia at GRU. If the applicant does not review this report or if there is no objection to the report, the report will be distributed after this period elapses. The accepted applicant will be provided with an opportunity to contest the contents of the report within the specified ten-calendar day period. (c) Omission of required information, including the failure to provide the consent, or submitting false or misleading information by the individual in any communication with the Medical College of Georgia may result in withdrawal of conditional acceptance. The School of Medicine will respect the laws of the state of Georgia or other state laws with regard to the person having a sealed juvenile record and having no obligation to reveal the records within the juvenile court system. (2) Criminal History Review Committee The Medical College of Georgia will create and maintain the Criminal History Review Committee (CHRC). The CHRC will be a standing committee established by the Dean of the Medical College of Georgia, and will include the Associate Dean for Admissions, the Associate Dean for Student Affairs, the Campus Associate Dean for Student and Multi-Cultural Affairs, GRU/UGA Medical Partnership Campus, the Associate Dean for Curriculum, the Associate Dean for Diversity Affairs, the Chair of the Student Promotions Committee, and will be supported by the Office of Legal Affairs. The CHRC shall meet on an as-needed basis to review applications referred to it by the Office of Admissions. As necessary, members may participate in committee meetings by telephone. Each member shall have one vote, and all decisions will be made by majority vote of the CHRC members present at the meeting at which an applicant is discussed. In the event of a tie vote, the matter will be referred to the Dean of the Medical College of Georgia for final decision. Each CHRC member will act in the best interest of the profession of medicine, potential patients of the applicant, and the GRU community when serving on the CHRC, and shall abstain from acting or voting in instances where there is a real or perceived conflict of interest with regard to an applicant before the CHRC. (3) Handling Adverse Reports pled to charge, reduced, accelerated rehabilitative disposition, adjudication withheld, Article 894, conditional diversion, conditional dismissal, conditional discharge, conditional release, deferred sentence, first offender program, supervision, suspended imposition of sentence, work release program, and Sunshine Law. 3 Arrests without Final Adjudication may include, but are not limited to, the following criminal records dispositions: dead docketed, adjourned, case is pending, continued, extradited, remanded, transferred, and dispositions that are not available.
4 Each conditionally accepted applicant case will be reviewed by the CHRC, focusing primarily on suitability for the profession of medicine, threats to individual patients, and risks to the Medical College of Georgia and the community. (a) The CHRC may require the individual to provide a detailed, written description and explanation of the information contained in the criminal records report along with appropriate documentation, such as police reports, certified court records and any institutional correspondence and orders. This information must be returned to the Medical College of Georgia within ten working days of the date the communication is sent to the individual. Any extension of this ten-day period must be set forth in writing signed by an authorized Medical College of Georgia representative. The Medical College of Georgia may also independently seek to obtain additional information, such as a copy of the original criminal charge, in order to corroborate the individual s explanation. The CHRC specifically certifies that before taking any adverse action against an applicant based on the Screening Report, the CHRC shall provide the applicant with: the Screening Report, a description in writing of the rights of the Consumer as prescribed by the Federal Trade Commission under 15 U.S.C (g)(c)(3), and a copy of which is attached hereto (the Rights of Consumers ). See Appendix. The CHRC has a continuing obligation to deliver a copy of the Rights of Consumers to each applicant receiving a Screening Report. (b) The CHRC will review the criminal record report and the applicant s explanation (if requested). No information that is provided will automatically result in the revocation of acceptance. A final decision with regard to matriculation will be made only after careful review of factors including but not limited to: the nature and seriousness of the offense, the circumstances under which the offense occurred, relationship between the duties to be performed as part of the educational program and the offense committed, the age of the person when the offense was committed, whether the offense was an isolated or repeated incident, the length of time that has passed since the offense, past employment and history of academic or disciplinary misconduct, evidence of successful rehabilitation, and the accuracy of any information provided by the applicant. (c) When the CHRC considers information on an accepted applicant, the focus of this consideration would be on whether to finalize the conditional offer of acceptance tendered by the Admissions Committee. The CHRC may also ask the applicant to provide additional information, appear in person, have a personal review conducted, or other measures determined necessary by the CHRC. All decisions will be made by majority vote of committee members present at the meeting. CHRC members who are not present will not be eligible to vote. In the event of a tie vote, the matter will be referred to the Dean of the Medical College of Georgia for a final decision. Accepted applicants will be informed that acceptance into the Medical College of Georgia at GRU does not guarantee the ability to complete all aspects of the program including clinical clerkships, obtain proper licensing, or meet other rehabilitation requirements under particular state laws. If a decision is reached to withdraw a conditional acceptance, the accepted applicant will be notified in writing within 10 days of the decision. (d) If the applicant s conditional acceptance is withdrawn, the Medical College of Georgia must notify the applicant that the Screening Report was used in deciding the outcome, under the FCRA.
5 (4) Subsequent Criminal Record Checks A criminal records check may be repeated after the initial check covered by this policy in accordance with applicable policies, procedures or practices of the GRU, Medical College of Georgia, or the Medical College of Georgia s clinical educational sites. (5) Record Keeping Of Reports (a) All criminal history information that is maintained by the Medical College of Georgia will be kept in a locked file that is located separately from the records in the accepted applicant s admission file. (b) Criminal record reports will be maintained for a period of time consistent with the Board of Regents retention schedule. (6) Evaluation of Policy This policy will be reviewed no less than every other year. Responsibilities The responsibilities each party has in connection with this policy are: (Party) Medical College of Georgia Office of Legal Affairs (Responsibility) Policy Implementation Legal Interpretation of Policy Appendix Summary of Your Rights Under the Fair Credit Reporting Act
Student Criminal Background Check Policy University of Missouri-St. Louis College of Optometry
Student Criminal Background Check Policy University of Missouri-St. Louis College of Optometry A. Introduction Recognizing the need to ensure the safety and well-being of patients, and to bolster the public
Reciprocity Application 12/2012
The Florida Board of Nursing Certified Nursing Assistants Reciprocity Application 12/2012 Phone.850. 245.4125 Fax.850.412.2207 4052 Bald Cypress Way, BIN C-13 Tallahassee, FL 32399-3252 [email protected]
3344-60-01 Employee background screening policy.
3344-60-01 Employee background screening policy. (A) Purpose In an effort to protect the campus community and its assets, the university seeks to ensure that individuals hired, promoted, or otherwise placed
Criminal Background Frequently Asked Questions
Criminal Background Frequently Asked Questions Q: Why does the Arkansas State Board of Nursing (ASBN) ask questions regarding criminal conviction(s)? A: According to the ASBN Nurse Practice Act (Sub Chapter
BACKGROUND CHECKS FOR EMPLOYMENT AT BALL STATE UNIVERSITY
BACKGROUND CHECKS FOR EMPLOYMENT AT BALL STATE UNIVERSITY I. POLICY STATEMENT: Ball State University is committed to employing qualified employees who possess good professional character and standards.
3416 1 st Avenue North Billings, MT. Phone 245-4946. Will do fingerprinting Monday Friday, 8:00-5:00. $12.00 per card
Federal Criminal Background Check The College of Education at Montana State University Billings (MSU B) requires that a national criminal history background check, including fingerprinting, be completed
APPLICANT INFORMATION (please print or type)
STATE OF MINNESOTA DEPARTMENT OF COMMERCE 85 7 TH PLACE EAST, SUITE 600 ST. PAUL, MINNESOTA 55101 (651) 539-1599 (For Department Use Only) DESIGNATED HOME STATE BUSINESS ENTITY INSURANCE ADJUSTER LICENSE
Criminal History Background Checks for Employment and Promotion
Policies Criminal History Background Checks for and Promotion Definitions Security sensitive areas are all of the physical locations at the utmbhealth (UTMB) designated by the President or his designee.
ALL APPLICANTS MUST COMPLETE THE FOLLOWING:
APPLICATION FOR ATHLETIC TRAINER LICENSE (This application may also be used for a temporary license) 1. An applicant for licensure shall meet one of the following requirements: a. Be a graduate of an approved
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
OLMSTED COUNTY ATTORNEY DOMESTIC ABUSE PROSECUTION POLICY POLICY STATEMENT:
OLMSTED COUNTY ATTORNEY DOMESTIC ABUSE PROSECUTION POLICY POLICY STATEMENT: It is the policy of the Olmsted County Attorney to pursue all domestic abuse allegations with zealous, yet discretionary prosecution
COLLATERAL CONSEQUENCES OF JUVENILE ADJUDICATIONS OF DELINQUENCY
COLLATERAL CONSEQUENCES OF JUVENILE ADJUDICATIONS OF DELINQUENCY This document is meant to provide general information about the collateral consequences of juvenile adjudications. This document is not
Restoration of Civil Rights. Helping People regain their Civil Liberties
Restoration of Civil Rights Helping People regain their Civil Liberties Consequences of a Felony Food Stamps and social security benefits: People convicted of a felony for possession or sell of controlled
FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY
FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY APPLICATION FOR TEACHING PERMIT Chapter 466.002, Florida Statutes Rule 64B5-7.005, Florida Administrative Code Applications will be accepted only if completed
REQUIREMENTS FOR LICENSURE:
Email: [email protected] INITIAL APPLICATION FOR A NURSE-MIDWIFE LICENSE 1. This license class does not include prescriptive authority. If you wish to hold a certificate for prescriptive authority, you
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
Federal & 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
S15Z0555. IN THE MATTER OF JONATHAN RICHARD HUDDLESTON. On January 28, 2013, Jonathan Richard Huddleston submitted an
In the Supreme Court of Georgia Decided: September 14, 2015 S15Z0555. IN THE MATTER OF JONATHAN RICHARD HUDDLESTON. PER CURIAM. On January 28, 2013, Jonathan Richard Huddleston submitted an application
FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY
DENTAL RADIOGRAPHY CERTIFICATION APPLICATION Chapter 466.004 and 466.017(5), Florida Statutes Rule 64B5-9.011, Florida Administrative Code SPECIAL TES AND INSTRUCTIONS: 1. A N-REFUNDABLE fee of $35.00
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.
Filing 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. * * * * * * * * * * * * *
Criminals; Rehabilitation CHAPTER 364 CRIMINAL OFFENDERS; REHABILITATION
1 MINNESOTA STATUTES 2013 364.02 Criminals; Rehabilitation CHAPTER 364 CRIMINAL OFFENDERS; REHABILITATION 364.01 POLICY. 364.02 DEFINITIONS. 364.021 PUBLIC AND PRIVATE EMPLOYMENT; CONSIDERATION OF CRIMINAL
Eligibility Requirements for RN Licensure in the State of Texas
February 2015 1 Eligibility Requirements for RN Licensure in the State of Texas These requirements listed here are not exclusive. It is the student s responsibility to update themselves with all requirements
FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY NON-PROFIT CORPORATION PERMIT APPLICATION
FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY N-PROFIT CORPORATION PERMIT APPLICATION Applications will be accepted only if completed by an officer of the non-profit organization. Any questions not applicable
INSTRUCTIONS FOR APPLICANTS WHO HOLD NBRC CERTIFICATION
Email: [email protected] [email protected] Medicine 717-783-1400/717-787-2381 Osteopathic 717-783-4858 APPLICATION FOR LICENSURE AS A RESPIRATORY THERAPIST This application can be used for licensure
ACCELERATED REHABILITATIVE DISPOSITION (ARD)
DISTRICT ATTORNEY'S OFFICE OF CHESTER COUNTY 201 WEST MARKET STREET, SUITE 4450 P.O. BOX 2746 WEST CHESTER, PA 19380-0989 TELEPHONE: (610) 344-6801 FAX: (610) 344-5905 ACCELERATED REHABILITATIVE DISPOSITION
A $100.00 application fee in the form of a money order made payable to LSBN must accompany this form
OFFICE USE ONLY: APPROVED BY (initial) DATE PERMIT ISSUED RN LICENSE NUMBER DATE RN LICENSE ISSUED ATTACH PHOTO With tape only - Attach a 2 x 2 inch passport type, fade-proof photo taken in the last six
MANDATORY REPORTING LAWS & RULES
Janet Napolitano Governor Joey Ridenour Executive Director Arizona State Board of Nursing 4747 North 7th Street, Suite 200 Phoenix AZ 85014-3653 Phone (602) 889-5150 Fax (602) 889-5155 E-Mail: [email protected]
**Make check or money order payable to the Montana Board of Barbers and Cosmetologists**
Page 1 of 5 MONTANA BOARD OF BARBERS AND COSMETOLOGISTS P. O. Box 200513 301 S PARK, 4 TH FLOOR (Delivery) Helena, Montana 59620-0513 (406) 841-2202 FAX (406) 841-2309 E-MAIL: [email protected] WEBSITE:
Texas Board of Nursing 333 Guadalupe, Ste 3-460, Austin, TX 78701 Phone: 512-305-7400
For Office Use Only Date: Amount: Texas Board of Nursing 333 Guadalupe, Ste 3-460, Austin, TX 78701 Phone: 512-305-7400 PETITION FOR DECLARATORY ORDER Audit #: FBI HX: YES NO Complete this application
18 Questions and Answers for Advising Potential PPOE Students
18 Questions and Answers for Advising Potential PPOE Students Question 1: Is a felony conviction always a bar to peace officer licensure in Minnesota? Answer: Yes. According to MN Rules a felony conviction
BACKGROUND CHECK POLICY UNIVERSITY POLICY
BACKGROUND CHECK POLICY UNIVERSITY POLICY Purpose: Roger Williams University and Roger Williams University School of Law (collectively referred to as the University ) established this Background Check
BOARD OF ATHLETIC TRAINING STATE OF FLORIDA EXAMINATION APPLICATION FOR LICENSURE
BOARD OF ATHLETIC TRAINING STATE OF FLORIDA EXAMINATION APPLICATION FOR LICENSURE You must read the laws and rules in order to determine your eligibility for licensure. Chapter 468, Part XIII, Florida
Standard No. 576-056-0000 MOTOR VEHICLE HISTORY CHECK. Purpose and Applicability
Standard No. 576-056-0000 MOTOR VEHICLE HISTORY CHECK Purpose and Applicability (1) Oregon State University is committed to protecting the security, safety, and health of faculty, staff, students and others,
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 PHARMACIST EXAMINATION APPLICATION FOR U.S. AND PUERTO RICO GRADUATES
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,
APPLICANT INFORMATION (please print or type)
STATE OF MINNESOTA DEPARTMENT OF COMMERCE 85 7 TH PLACE EAST, SUITE 600 ST. PAUL, MINNESOTA 55101 (651) 539-1599 (For Department Use Only) TRAVEL INSURANCE PRODUCER BUSINESS ENTITY LICENSE APPLICATION
Arizona State Board of Nursing (AZBN) School Nurse Initial & Renewal Certification Instructions
IMPTANT Arizona State Board of Nursing (AZBN) School Nurse Initial & Renewal Certification Instructions School Nurse Certification is Valid in Arizona only. School Nurse Certification expires every 6 years.
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 PHARMACIST EXAMINATION APPLICATION FOR U.S. AND PUERTO RICO GRADUATES
USA WRESTLING BACKGROUND SCREENING PROGRAM (Amended 12/04/12)
USA WRESTLING BACKGROUND SCREENING PROGRAM (Amended 12/04/12) Background Information As most are aware, USA Wrestling ( USAW ) implemented a voluntary background screening procedure in 2003, and will implement
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
Answering Questions About Your Juvenile Criminal History on a Job Application in Florida
Answering Questions About Your Juvenile Criminal History on a Job Application in Florida Many employment applications include a question about the applicant s past criminal history. Youth and young adults
MASTER OF LIBERAL ARTS & SCIENCES PROGRAM
MASTER OF LIBERAL ARTS & SCIENCES PROGRAM APPLICATION INSTRUCTIONS for DEGREE-SEEKING APPLICANTS, including those who wish to pursue the Climate Change and Society courses. *Application instructions for
RULES OF SUPREME COURT OF VIRGINIA PART THREE A CRIMINAL PRACTICE AND PROCEDURE APPENDIX
RULES OF SUPREME COURT OF VIRGINIA PART THREE A CRIMINAL PRACTICE AND PROCEDURE APPENDIX Form 6. Suggested Questions to Be Put by the Court to an Accused Who Has Pleaded Guilty (Rule 3A:8). Before accepting
CHAPTER 11 LICENSURE OF NURSES IN FLORIDA, THE CREDENTIALS COMMITTEE AND QUESTIONS AND ANSWERS
CHAPTER 11 LICENSURE OF NURSES IN FLORIDA, THE CREDENTIALS COMMITTEE AND QUESTIONS AND ANSWERS The basic licensure requirements for nurses in Florida are enacted into law by the Florida Legislature. Licensure
IOWA PLUMBING & MECHANICAL SYSTEMS BOARD INSTRUCTIONS FOR APPLICATION FOR CONTRACTOR LICENSES
IOWA PLUMBING & MECHANICAL SYSTEMS BOARD INSTRUCTIONS FOR APPLICATION FOR CONTRACTOR LICENSES Submit completed applications with a check or money order to: Iowa Plumbing and Mechanical Systems Board Iowa
The Consequences of a Juvenile Delinquency Record in Minnesota
The Consequences of a Juvenile Delinquency Record in Minnesota 1. Is it true that a juvenile delinquency record will not limit a young person s future opportunities in Minnesota? No, it is not true. Although
BOARD OF MEDICINE APPLICATION MATERIALS FOR INITIAL REGISTRATION & RENEWAL OF INTERN/RESIDENT/FELLOW & HOUSE PHYSICIAN PURSUANT TO 458.345, F.S.
BOARD OF MEDICINE APPLICATION MATERIALS FOR INITIAL REGISTRATION & RENEWAL OF INTERN/RESIDENT/FELLOW & HOUSE PHYSICIAN PURSUANT TO 458.345, F.S. DEPARTMENT OF HEALTH 1 TABLE OF CONTENTS SECTION I: Application
DEPARTMENT OF NURSING BOX T-0500, STEPHENVILLE, TEXAS 76402 APPLICATION FORM Instructions
DEPARTMENT OF NURSING BOX T-0500, STEPHENVILLE, TEXAS 76402 APPLICATION FORM Instructions A point system is used to select students for admission to the Nursing Program at Tarleton State University (TSU).
I. ELIGIBILITY FOR BOTH PRE-CHARGE AND POST-CHARGE DIVERSION: 1. Admit guilt and acknowledge responsibility for their action.
ANOKA COUNTY ADULT CRIMINAL DIVERSION PLAN Effective July 1, 1994 - Revised 8/1/02, 9/5/07, 9/11/08 (Revisions apply only to crimes occurring on or after 9/1/08). The following plan has been developed
Application for Business Entity Insurance License (Please Print or Type)
Check appropriate boxes for license requested. Resident License Non-Resident License o Identify Home State: o Identify Home State License #: New Application Additional Line(s) of Authority Application
Maryland Insurance Administration Individual Producer License Renewal / Reinstatement Checklist
Maryland Insurance Administration Individual Producer License Renewal / Reinstatement Checklist Important Update: The attached application and supplement may be used to renew or reinstate an existing Maryland
Applicants will be notified within 15 working days of receipt of a completed application as to the status of the application.
2/09, 03/11, 11/11, 01/13, 01/15 Page 1 of 10 MONTANA BOARD OF RADIOLOGIC TECHLOGISTS 301 SOUTH PARK, 4TH FLOOR PO BOX 200513 HELENA, MONTANA 59620-0513 (406) 841-2202 FAX: (406) 841-2305 email: [email protected]
PLEASE ALLOW AT LEAST 60 DAYS FOR PROCESSING INSTRUCTIONS FOR APPLICANTS WHO HOLD NCCPA CERTIFICATION
Regular Mailing Address P.O. BOX 2649 HARRISBURG, PA 17105-2649 Email: [email protected] Courier Delivery Address 2601 NORTH THIRD STREET HARRISBURG, PA 17110 717-783-1400/717-787-2381 APPLICATION FOR
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
Criminal Background Check Policy
Authority: Board of Regents Policy 20-19 Criminal Background Check Policy No: S-14.5 Date: March 10, 2008, amended February 2013 The Board of Regents Policy 20-19 requires that a criminal background check
Pre-Employment Background Checks. October 2, 2006
Date Effective October 2, 2006 City Manager Revision Date Effective Code Number HR19 Human Resources Responsible Key Business Purpose: The City of Charlotte seeks to ensure the safety and security of employees
APPLICATION TO REGISTER PAIN MANAGEMENT CLINIC
APPLICATION TO REGISTER PAIN MANAGEMENT CLINIC FLORIDA STATUTES Sections 458.3265 and 459.0137, Florida Statutes BOARD RULES Chapter 64B8-9, Florida Administrative Code Chapter 64B15-14, Florida Administrative
Application for New Louisiana Pharmacy Technician Candidate Registration
Louisiana Board of Pharmacy 3388 Brentwood Drive Baton Rouge, Louisiana 70809-1700 Telephone 225.925.6496 ~ Facsimile 225.925.6499 www.pharmacy.la.gov ~ E-mail: [email protected] Application for New
2. Be of good moral character. Have 2 recommendations completed on page 3.
STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS P.O. BOX 2649 HARRISBURG, PA 17105-2649 717-783-1389 FAX 717-787-7769 Email [email protected] Website www.dos.pa.gov/social
ACCELERATED REHABILITATIVE DISPOSITION (ARD)
DISTRICT ATTORNEY S OFFICE OF CHESTER COUNTY 201 WEST MARKET STREET, SUITE 4450 P.O. BOX 2746 WEST CHESTER, PA 19380-0989 TELEPHONE: (610) 344-6801 FAX: (610) 344-5905 ACCELERATED REHABILITATIVE DISPOSITION
APPLICATION FOR PHARMACIST EXAMINATION
Applicant s Name: 9901/001 Application $ 50.00 9901/001 Licensure fee $ 165.00 9901/006 Regulatory fee $ 10.00 9901/001 Application $300.00 9901/001 Score Transfer $165.00 9901/006 Regulatory fee $10.00
Standards and Requirements for Specialist Certification and Recertification
Standards and Requirements for Specialist Certification and Recertification The following are Standards and Requirements for Certification and Recertification of lawyers as Criminal Law Specialists. The
Mailing Address: State Board of Funeral Directors PO Box 2649 Harrisburg, PA 17105-2649 APPLICATION FOR FUNERAL SUPERVISOR LICENSE
48-FS 100 (3/6/15) STATE BOARD OF FUNERAL DIRECTORS Telephone: 717-783-3397 Fax: 717-705-5540 E-mail: [email protected] Website:w w w.dos.pa.gov/funeral Mailing Address: State Board of Funeral Directors
REVISED 07-15 STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS P.O. BOX 2649 HARRISBURG, PA 17105-2649
STATE BOARD OF SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS AND PROFESSIONAL COUNSELORS P.O. BOX 2649 HARRISBURG, PA 17105-2649 Email [email protected] www.dos.pa.gov/social APPLICATION FOR A LICENSE
Policy on Background Checks and Credential Verifications
HUMAN RESOURCES Effective Date: October 2013 Date Revised: N/A Supersedes: Background Check Policy, Credential Verification Policy Related Policies: Responsible Office/Department: Human Resources Management
Individual Application for Massage Therapy Iowa Department of Public Health/Bureau of Professional Licensure Board Office Telephone (515) 281-6959
For Office Use License #: Date Issued: $120 Individual Application for Massage Therapy Iowa Department of Public Health/Bureau of Professional Licensure Board Office Telephone (515) 281-6959 Applicant
Department of Nursing. Box T- 0500, Stephenville, Texas 76402 APPLICATION FORM. Instructions
Department of Nursing Box T- 0500, Stephenville, Texas 76402 APPLICATION FORM Instructions A point system is used to select students for admission to the Nursing Program at Tarleton State University (TSU).
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
HOW 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
Arkansas State Board of Public Accountancy
APPENDIX ONE PHYSICAL ADDRESS The principle office and official address of the Board is as follows: Arkansas State Board of Public Accountancy, 101 East Capitol Avenue, Suite 450, Little Rock, AR 72201.
APPRAISAL MANAGEMENT COMPANY RENEWAL APPLICATION
Complete, sign, and submit this form along with the items listed below to the Division. Entity Name: Email: Business Address: City: State: Zip: Ph: Fax: Registered Agent: Email: City: State: Zip: Ph: Fax:
August 18, 2015. Admission to Nursing Program, GENERIC OPTION January 2016. Dear Potential Applicant:
August 18, 2015 Admission to Nursing Program, GENERIC OPTION January 2016 Dear Potential Applicant: Thank you for your interest in the nursing program at Polk State College. This packet contains vital
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)
STATE OF FLORIDA BOARD OF ACUPUNCTURE APPLICATION FOR LICENSURE WITH INSTRUCTIONS
STATE OF FLORIDA BOARD OF ACUPUNCTURE APPLICATION FOR LICENSURE WITH INSTRUCTIONS Board of Acupuncture 4052 Bald Cypress Way, Bin # C-06 Tallahassee, FL 32399-3256 (850) 488-0595 September 2012 Edition
OCCUPATIONAL THERAPY ASSISTANT or OCCUPATIONAL THERAPIST
STATE OF UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING APPLICATION FOR LICENSURE OCCUPATIONAL THERAPY ASSISTANT or OCCUPATIONAL THERAPIST APPLICATION INSTRUCTIONS AND INFORMATION General Statement:
May 6, 2015. Admission to Nursing Program, GENERIC OPTION August 2015. Dear Potential Applicant:
May 6, 2015 Admission to Nursing Program, GENERIC OPTION August 2015 Dear Potential Applicant: Thank you for your interest in the nursing program at Polk State College. This packet contains vital information
COLORADO DEPARTMENT OF REGULATORY AGENCIES. Division of Professions and Occupations Office of Speech-Language Pathology Certification
COLORADO DEPARTMENT OF REGULATORY AGENCIES Division of Professions and Occupations Office of Speech-Language Pathology Certification 4 CODE OF COLORADO REGULATIONS (CCR) 748-1 RULES REGULATING SPEECH-LANGUAGE
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
TECHNICIAN-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: [email protected]
STATE OF OHIO DEPARTMENT OF REHABILITATION AND CORRECTION I. AUTHORITY
STATE OF OHIO SUBJECT: Certificate of Achievement and PAGE: 1 of 6 Employability NUMBER: 02-REN-05 RULE/CODE REFERENCE: SUPERSEDES: HB 86 02-REN-05 dated 12/01/11 DEPARTMENT OF REHABILITATION AND CORRECTION
Private 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
CHECK THE CIRCUMSTANCE UNDER WHICH YOU ARE SEEKING A TEMPORARY LICENSE: REQUIRED DOCUMENTS
Regular Mailing Address P.O. BOX 2649 HARRISBURG, PA 17105-2649 717-783-1400/717-787-2381 Email: [email protected] Courier Delivery Address 2601 NORTH THIRD STREET HARRISBURG, PA 17110 APPLICATION FOR
Criminal Justice System Commonly Used Terms & Definitions
Criminal Justice System Commonly Used Terms & Definitions A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Accused: Acquittal: Adjudication: Admissible Evidence: Affidavit: Alford Doctrine: Appeal:
Dear Applicant: Criteria for admission to the program includes:
Dear Applicant: Thank you for your interest in the Social Work Program at Defiance College. The Program has a long history of training baccalaureate students to become effective, beginning level, social
