Lacey Township School District

Size: px
Start display at page:

Download "Lacey Township School District"

Transcription

1 HR Lacey Township School District APPLICANT CHECKLIST FOR SUBSTITUTE TEACHER CERTIFICATION Thank you for your interest in Lacey Township School District! After completing your online application and interview, please review the steps below to ensure a smooth process in obtaining your certification. Applicant Name: Applicant Phone Number: Applicant 1. Substitute applicant must first complete the criminal history review/fingerprinting process (initial application or archive application; refer to separate fingerprinting instructions ) 2. Once criminal history review/fingerprinting clearance letter has been received, applicant must also complete/submit the following to the Human Resources Department: Substitute teacher application Oath of Allegiance (must be notarized) Undergraduate transcripts showing 60 credits (must be sealed original with school stamp; not student copy) $125 money order or check made out to Commissioner of Education Criminal History/Fingerprint clearance letter 3. Upon receipt of above, HR will send the completed application packet to the Ocean County Superintendent Office which will process it and send the approved county Substitute Certificate back to HR. HR will notify the applicant when the certificate has been received. Lacey Township School District HR contact: Dina Scala, HR Manager, ext. 1013, dscala@laceyschools.org 200 Western Blvd., Lanoka Harbor, NJ rev 2/2018 DS

2 HR Lacey Township School District CRIMINAL HISTORY REVIEW/FINGERPRINTING INSTRUCTIONS This process must be completed before you begin working. The criminal history review is a requirement in the State of New Jersey. Your employment is contingent upon completing your criminal history review/fingerprinting, receiving a clear criminal history background check and returning all required paperwork. Note: You must have access to a printer to print your IdentoGo universal fingerprint form and/or receipt. If you have any issues, you may contact the Criminal History Review Unit at INITIAL (FIRST TIME FINGERPRINTING) / NON-ARCHIVE: ONLY USE THESE INSTRUCTIONS IF: you were never fingerprinted by the State of NJ/DOE or were fingerprinted prior to 2003 Go to: and follow the steps below: Click on new applicant, then click on New Applicant Process Click on New Administration Fee Request (New Applicants Only) to begin the process On the Applicant Authorization and Certification page: Choose number 1 (for all positions except Bus Driver or Bus Aides) Choose number 2 (for Bus Driver or Bus Aide) Enter your personal information (name, address, etc.). In Job Category, select your title (e.g. Substitute Teacher, Classroom Teacher, etc.) In School Info category, click the option for Public School Selection, then Select County Ocean (29) Select Contractor Lacey Township (2480) Pay the administration fee: Methods of payment are VISA, Master Card, AmEx or Discover. You will now be presented with 3 options, select each option as per below. Option 1: View/Print your administration fee payment confirmation page click on this option and print your confirmation page. Option 2: Complete and print your IdentoGo universal fingerprint form click on this option and fill in the required fields, then click submit. Make sure to print this form and bring it to your fingerprinting appointment (you will be given the option to print after you click submit). Option 3: Schedule your fingerprinting appointment click on this option and follow the instructions to make your appointment. Use the information on your IdentoGo universal fingerprint form to complete the online application. Make sure to write your applicant ID number on your IdentoGo universal fingerprint form when you receive it. You must bring this form to your fingerprinting appointment. Review and submit your request and then print your receipt. Bring your receipt from IdentoGo fingerprinting with you when you come to the Lacey Township Board Office to complete your new hire paperwork. (OVER)

3 ARCHIVE Process: ONLY USE THESE INSTRUCTIONS IF: you have already been fingerprinted by the State of NJ/DOE on or after February 21, 2003 Go to: and follow the steps below: Click on archive applicant, then Criminal History Review Archive Process Click on Archive Application Request to begin the process On the Applicant Authorization and Certification page: Choose number 1 (for all positions except Bus Driver or Bus Aides) Choose number 2 (for Bus Driver or Bus Aide) You will need your PCN number to continue with the process. To obtain your PCN number, go to and enter your social security number and birth date to view your most recent PCN number. In School Info category, click the option for Public School Selection, then Select County Ocean (29) Select Contractor Lacey Township (2480) Methods of payment are VISA, Master Card, American Express or Discover. Review before you submit your request then print your receipt. Bring your receipt with you when you come to the Lacey Township Board Office to complete your new hire paperwork. TRANSFER Process: ONLY USE THESE INSTRUCTIONS IF: you have already been fingerprinted by the State of NJ/DOE on or after March 2003 as a Substitute or Bus Driver and have been continuously employed by a school since you were fingerprinted Go to: and follow the steps below: Click on transfer applicant, then Criminal History Review Transfer Process Click on Transfer Request to begin the process Select the option applicable to the position for which you are requesting the transfer. You may need your PCN number to continue with the process. To obtain your PCN number, go to and enter your social security number and birth date to view your most recent PCN number. In School Info category, click the option for Public School Selection, then Select County Ocean (29) Select Contractor Lacey Township (2480) Methods of payment are VISA, Master Card, American Express or Discover. Review before you submit your request then print your receipt. Rev DS

4 (REV ) STATE OF NEW JERSEY DEPARTMENT OF EDUCATION DIVISION OF FIELD SERVICES AND OFFICE OF CERTIFICATION AND INDUCTION SUBSTITUTE CREDENTIAL APPLICATION COUNTY: NOTE: THIS APPLICATION MUST BE TRANSMITTED TO THE COUNTY OFFICE IN WHICH THE SPONSORING DISTRICT IS LOCATED This credential will be issued for a five-year period, but the holder may serve for no more than 20 total instructional days in the same position in one school district during the school year unless approved by the Executive County Superintendent for an additional 20 instructional days pursuant to N.J.A.C. 6A: 9B-6.5(b). Such credentials, which are issued by the Executive County Superintendent of Schools under the authority of the State Board of Examiners, are designed only for emergency purposes when the supply of properly certificated substitutes is inadequate to staff a school. They are intended only for persons temporarily performing the duties of a fully certificated and regularly employed teacher. TO BE COMPLETED BY APPLICANT -- Please Type or Print Clearly Name (First) (Middle/Maiden) (Last) Social Security # Address (Street) (City) (State) (Zip) Date of Birth Address Telephone Are you a citizen of the United States? Yes No If no, have you filed an Affidavit of Intent to Become a Citizen? Yes No If yes, Alien Registration # NOTE: The Affidavit of Intent to Become a Citizen is not a requirement for the substitute credential. Have you ever been convicted of a crime in this or any other state? Yes No If yes, give the name of the municipality and attach statement giving details. Have you ever had an educator s certificate revoked or suspended in this or any other state? Yes No If yes, attach statement giving details. Have you taken the Oath of Allegiance? Yes No EDUCATION Regionally-Accredited College Name Location Degree / Degree Date Major # Credits WORK EXPERIENCE (teaching) I certify that the above statements and data are correct: (Signature of Applicant) (Date) FOR DISTRICT OR DISTRICT DESIGNEE* USE: AFFIRMING TRANSMITTAL OF APPLICATION _ Print Name of District Representative or District Designee Representative Name of District for Which Application is Transmitted Signature of District Representative or District Designee Representative Date Name Vendor / Firm if Transmitted by Designee *District designee is defined as a vendor / firm that contracts with the district for this purpose. FOR COUNTY USE: REGULAR SUBSTITUTE APPLICATION VOCATIONAL / SCHOOL NURSE APPLICATION Application Oath Transcripts Fee Date of Criminal History Approval if applicable Date of Emergent Hire Approval if applicable CERTIFICATE # DATE OF ISSUE or For vocational applicants/notarized statement of previous employment or valid occupational license. RN License # Exp.Date

5 IMPORTANT: This form is to be completed by only those individuals who are U.S. citizens. See Section B below. A. Basic Information Please print your name as it appears on any documentation that you are required to submit Last Name First Name Middle Name or Initial Street Address City State Zip Social Security Number Date of Birth: Month Day Year Tracking Number New Jersey State Department of Education Office of Certification and Induction OATH OF ALLEGIANCE / VERIFICATION OF ACCURACY Address Phone Number Including Area Code Are you applying for the New Charter School Certificates? Circle whichever applies YES NO Are you a military veteran? Circle whichever applies YES NO Endorsement Information. Please enter below the code and print the name of each endorsement for which you are applying. Code Name of Endorsement B. Oath of Allegiance Choose one of the following. Option I I, do solemnly swear, (or affirm) that I will support the Constitution of the United States and the Constitution of the State of New Jersey, and that I will bear true faith and allegiance to the same and to the governments established in the United States and in this State, under the authority of the people, so help me God. Option II I, do solemnly swear, (or affirm) that I will support the Constitution of the United States and the Constitution of the State of New Jersey, and that I will bear true faith and allegiance to the same and to the governments established in the United States and in this State, under the authority of the people. C. Certification Failure to complete these items will result in rejection of the candidate s application for certification. Circle whichever applies 1.Have you ever been convicted of, pled guilty, no contest or nolo contendere to, or had adjudication withheld to a crime or offense, including DUI, in New Jersey or any other state or jurisdiction? If yes, complete and submit a Criminal/Offense Information Form. Yes No 2. Have you ever had an education or other professional certificate, license or credential revoked, suspended, invalidated or denied for cause in New Jersey or any other state or jurisdiction?* Yes No 3. Have you ever surrendered or relinquished an education or other professional certificate, license or credential in New Jersey or any other state or jurisdiction? * Yes No 4. Are you the subject of any pending action or proceedings against your education or other professional certificate(s), license(s) or credential(s) in New Jersey or any other state or jurisdiction? * Yes No

6 5. Have you ever resigned, retired or been dismissed or suspended from an education-related position in New Jersey or any other state or jurisdiction following allegations of misconduct? * Yes No 6. Are you the subject of any civil, criminal or administrative investigation in New Jersey or any other state or jurisdiction? * Yes No * If any answer to Questions 2 through 6 is yes, complete and submit an Additional Information For the Oath of Allegiance Form. D. Verification of Accuracy I certify that all statements and information provided herein are true and accurate. Applicant s Signature (in ink) Date Sworn and subscribed to before me this day of, 20 Notary Seal Notary Signature Once completed, mail the form to: Rev New Jersey State Department of Education Office of Certification and Induction P.O. Box 500 Trenton, New Jersey Attention: Oath of Allegiance/Verification of Accuracy

Substitute Application Instructions

Substitute Application Instructions Substitute Application Instructions Thank you for your interest in being a substitute teacher or nurse at Bay Head School. Once you have compiled all of the documents listed below, please bring them to

More information

NJ SUBSTITUTE TEACHER CERTIFICATION INSTRUCTIONS

NJ SUBSTITUTE TEACHER CERTIFICATION INSTRUCTIONS NJ SUBSTITUTE TEACHER CERTIFICATION INSTRUCTIONS NJ Substitute Teacher Certification Information Substitute credentials are valid for 5 years. You are able to renew your substitute teacher certification

More information

WASHINGTON STATE CONTINUING EDUCATIONAL STAFF ASSOCIATE CERTIFICATION REQUIREMENTS

WASHINGTON STATE CONTINUING EDUCATIONAL STAFF ASSOCIATE CERTIFICATION REQUIREMENTS WASHINGTON STATE CONTINUING EDUCATIONAL STAFF ASSOCIATE CERTIFICATION REQUIREMENTS School Nurse, School Occupational Therapist, School Physical Therapist, School Social Worker, School Speech Language Pathologist

More information

SPEECH-LANGUAGE PATHOLOGY ASSISTANT (SLPA) REQUIREMENTS AND INSTRUCTIONS

SPEECH-LANGUAGE PATHOLOGY ASSISTANT (SLPA) REQUIREMENTS AND INSTRUCTIONS South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Examiners in Speech-Language Pathology and Audiology 110 Centerview Dr. Columbia SC 29210 P.O. Box 11329 Columbia SC

More information

Employee Registration Information

Employee Registration Information Employee Registration Information The licensee (employer) must submit the application on behalf of every employee hired to work as a private detective or armed security guard, even if the employee has

More information

Pawling Central School District 515 Route 22 Pawling, NY (845) (845) Fax

Pawling Central School District 515 Route 22 Pawling, NY (845) (845) Fax Pawling Central School District 515 Route 22 Pawling, NY 12564 (845) 855-2028 (845) 855-2152 Fax The Pawling Central School District is an equal opportunity school district/employer, which does not discriminate

More information

NURSING HOME ADMINISTRATOR REQUIREMENTS AND INSTRUCTIONS

NURSING HOME ADMINISTRATOR REQUIREMENTS AND INSTRUCTIONS South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Long Term Health Care Administrators 110 Centerview Dr. Columbia SC 29210 P.O. Box 11329 Columbia SC 29211-1329 Phone:

More information

Substitute Teacher Certificate Instruction Sheet

Substitute Teacher Certificate Instruction Sheet Alpine Public School District (201) 768 8255 500 Hillside Avenue Fax (201) 768 7855 Alpine, NJ 07620 Substitute Teacher Certificate Instruction Sheet For issuance of a Bergen County substitute teacher

More information

APPLICATION CHECKLIST IMPORTANT

APPLICATION CHECKLIST IMPORTANT State of Florida Department of Business and Professional Regulation Division of Professions: Talent Agencies Application for Change of Owner or Operator Form # DBPR TA-2 APPLICATION CHECKLIST IMPORTANT

More information

A $ application fee in the form of a money order made payable to LSBN must accompany this form.

A $ 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 2 X 2 PHOTO With tape only - Attach a 2 x 2 inch passport type, fade-proof photo taken in the last

More information

PRIMARY ELECTION PETITION NOMINATING CANDIDATES FOR MUNICIPAL OFFICE. Clerk of the Municipality of

PRIMARY ELECTION PETITION NOMINATING CANDIDATES FOR MUNICIPAL OFFICE. Clerk of the Municipality of Office of: PRIMARY ELECTION PETITION NOMINATING CANDIDATES FOR MUNICIPAL OFFICE Democrat Republican TO: Clerk of the of We, the signers of this petition, hereby certify that we reside in the municipality

More information

SPEECH-LANGUAGE PATHOLOGY ASSISTANT (SLPA) REQUIREMENTS AND INSTRUCTIONS

SPEECH-LANGUAGE PATHOLOGY ASSISTANT (SLPA) REQUIREMENTS AND INSTRUCTIONS South Carolina Board of Examiners in Speech-Language Pathology and Audiology 110 Centerview Dr. Columbia SC 29210 P.O. Box 11329 Columbia SC 29211-1329 Phone: 803-896-4655 Contact.Speech@llr.sc.gov Fax:

More information

MAINE STATE BOARD OF NURSING

MAINE STATE BOARD OF NURSING MAINE STATE BOARD OF NURSING 158 STATE HOUSE STATION 161 CAPITOL STREET AUGUSTA, MAINE 04333-0158 (207) 287-1138 APPLICATION FOR LICENSE AS A REGISTERED PROFESSIONAL NURSE BY ENDORSEMENT DO NOT WRITE IN

More information

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA): Florida Certified Nursing Assistant Examination Application *APPCNAFL* Instructions: Please go to www.prometric.com/nurseaide/fl to print the current version of this application and all other forms. DO

More information

NORTH CAROLINA MARRIAGE AND FAMILY THERAPY LICENSURE BOARD

NORTH CAROLINA MARRIAGE AND FAMILY THERAPY LICENSURE BOARD NORTH CAROLINA MARRIAGE AND FAMILY THERAPY LICENSURE BOARD Mailing Address: Post Office Box 5549, Cary, NC 27512 Phone: (919) 469-8081 Fax: (919) 336-5156 Email: ncmftlb@nc.rr.com Web: www.nclmft.org APPLICATION

More information

APPLICATION FOR REINSTATEMENT OF AN EDUCATOR S LICENSE (PRINT OR TYPE ALL INFORMATION)

APPLICATION FOR REINSTATEMENT OF AN EDUCATOR S LICENSE (PRINT OR TYPE ALL INFORMATION) FORM 1R REINSTATEMENT MISSISSIPPI DEPARTMENT OF EDUCATION Office of Educator Licensure P. O. Box 771 Jackson, MS 39205-0771 TELEPHONE (601) 359-3483 OFFICE USE ONLY Application Complete / / APPLICATION

More information

Reactivation Requirements

Reactivation Requirements South Carolina Department of Labor, Licensing and Regulation South Carolina Board of Medical Examiners 110 Centerview Dr Columbia SC 29210 P.O. Box 11289 Columbia SC 29211 Phone: 803-896-4500 Medboard@llr.sc.gov

More information

NJ CRIMINAL HISTORY INSTRUCTIONS

NJ CRIMINAL HISTORY INSTRUCTIONS NJ CRIMINAL HISTORY INSTRUCTIONS New Jersey Criminal History Information If... *You have never been fingerprinted for Public School Employment, or *You were fingerprinterd before February 21, 2003... You

More information

Employee Statement and Security Guard Application FEE $36

Employee Statement and Security Guard Application FEE $36 FOR OFFICE USE ONLY CASH#: UID: PREV. UID: CLASS: CODE: New York State Department of State Division of Licensing Services P.O. Box 22052 Albany, NY 12201-2052 Customer Service: (518) 474-7569 www.dos.ny.gov

More information

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA): Florida Certified Nursing Assistant Examination Application *APPCNAFL* Instructions: Please go to www.prometric.com/nurseaide/fl to print the current version of this application and all other forms. DO

More information

APPLICATION FOR PSYCHOLOGY ASSISTANT REGISTRATION 1

APPLICATION FOR PSYCHOLOGY ASSISTANT REGISTRATION 1 APPLICATION FOR PSYCHOLOGY ASSISTANT REGISTRATION Applicant Name: Date of Application (year / month / day): Mailing Address: Please inform the College in writing of any changes within 30 days. Phone Number

More information

Reserve Firefighter Application Packet Level II Post Interview Questionnaire

Reserve Firefighter Application Packet Level II Post Interview Questionnaire AN EQUAL OPPORTUNITY EMPLOYER Reserve Firefighter Application Packet Level II Post Interview Questionnaire Job Requisition #: Date: Please type or print in black ink. Complete all items. Incomplete or

More information

Employer Approval for Alaska Limited Governmental Notary Commission

Employer Approval for Alaska Limited Governmental Notary Commission Employer Approval for Alaska Limited Governmental Notary Commission The Lieutenant Governor may commission Limited Governmental Notaries Public, who are State, municipal or federal employees authorized

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. 1 of 11 State of Florida Department of Business and Professional Regulation Building Code Administrators and Inspectors Board Application for Authorization to Take the Principles and Practice Examination

More information

EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF

EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF PHASE I 1. Secure application form in person, mail, telephone, or website (www.pittsville.k12.wi.us). 2. Return the completed application form with a

More information

INSTRUCTIONS FOR REINSTATEMENT, REACTIVATION AND RESUMPTION OF PRACTICE APPLICATION OF A NEW JERSEY LICENSE

INSTRUCTIONS FOR REINSTATEMENT, REACTIVATION AND RESUMPTION OF PRACTICE APPLICATION OF A NEW JERSEY LICENSE Division of Consum er Affairs State Board of Professional Engineers and Land Surveyors rd 124 Halsey Street, 3 Floor, Newark, NJ 07102 www.njconsumeraffairs.gov (973) 504-6460 INSTRUCTIONS FOR REINSTATEMENT,

More information

Application for Temporary Authorization Original OR Renewal (Instructional)

Application for Temporary Authorization Original OR Renewal (Instructional) FORM 38 (Revised 1/02) PART I - Received by County PART II - PERSONAL STATEMENT OF APPLICANT PLEASE TYPE OR PRINT IN INK. Application for Original OR Renewal (Instructional) WV DEPARTMENT OF EDUCATION

More information

NOMINATING PETITION FOR NOVEMBER SCHOOL ELECTION

NOMINATING PETITION FOR NOVEMBER SCHOOL ELECTION NOMINATING PETITION FOR NOVEMBER SCHOOL ELECTION PETITION MUST BE FILED WITH COUNTY CLERK S OFFICE ELECTIONS DIVISION One Bergen County Plaza Room 130, Hackensack, NJ 07601 On or before 4:00 PM on the

More information

VOCATIONAL NURSING APPLICATION PROCEDURES

VOCATIONAL NURSING APPLICATION PROCEDURES VOCATIONAL NURSING APPLICATION PROCEDURES 1. Summit you VN application to the VN office at ITECC G 114. 2. Apply for college enrollment and financial aid at Oliveira Student Center as early as March for

More information

Los Angeles Unified School District

Los Angeles Unified School District Los Angeles Unified School District 1360 West Temple Street, Los Angeles, CA 90026 Mailing Address: P.O. Box 513307, Los Angeles, CA 90051 Telephone: (213) 625-6506 Fax: (213) 481-2825 Roy Romer Superintendent

More information

INSTRUCTIONS AND REQUIREMENTS FOR REINSTATEMENT / REACTIVATION OF A SOUTH CAROLINA RN OR LPN LICENSE

INSTRUCTIONS AND REQUIREMENTS FOR REINSTATEMENT / REACTIVATION OF A SOUTH CAROLINA RN OR LPN LICENSE INSTRUCTIONS AND REQUIREMENTS FOR REINSTATEMENT / REACTIVATION OF A SOUTH CAROLINA RN OR LPN LICENSE Compact State Information South Carolina is a member of the Nurse Licensure Compact (NLC). The NLC allows

More information

CITY OF LAKE MARY 100 N. COUNTRY CLUB RD MAILING ADDRESS: P. O. BOX LAKE MARY, FL PHONE

CITY OF LAKE MARY 100 N. COUNTRY CLUB RD MAILING ADDRESS: P. O. BOX LAKE MARY, FL PHONE Date - - S.S. # - - CITY OF LAKE MARY 100 N. COUNTRY CLUB RD MAILING ADDRESS: P. O. BOX 958445 LAKE MARY, FL 32795-8445 PHONE 407-585-1445 EMPLOYMENT APPLICATION This City is an Equal Opportunity Employer

More information

NOMINATING PETITION FOR NOVEMBER SCHOOL ELECTION

NOMINATING PETITION FOR NOVEMBER SCHOOL ELECTION NOMINATING PETITION FOR NOVEMBER SCHOOL ELECTION PETITION MUST BE FILED WITH COUNTY CLERK S OFFICE ELECTIONS DIVISION One Bergen County Plaza Room 130, Hackensack, NJ 07601 On or before 4:00 PM on the

More information

City of Hudson Department of Fire 520 Warren Street Hudson, New York 12534

City of Hudson Department of Fire 520 Warren Street Hudson, New York 12534 City of Hudson Department of Fire 520 Warren Street Hudson, New York 12534 Standard Operating Procedure Membership Application Process Revised January 15, 2014 The intent of this procedure is to insure

More information

MARYLAND BOARD OF PHYSICIANS P.O. Box 2571 Baltimore, Maryland

MARYLAND BOARD OF PHYSICIANS P.O. Box 2571 Baltimore, Maryland MARYLAND BOARD OF PHYSICIANS P.O. Box 2571 Baltimore, Maryland 21215 www.mbp.state.md.us E-mail: mdh.mbppadispense@maryland.gov : ADDENDUM FOR PHYSICIAN ASSISTANT (PA) TO DISPENSE PRESCRIPTION DRUGS INSTRUCTIONS

More information

New Jersey Motor Vehicle Commission

New Jersey Motor Vehicle Commission Instructor License Type & Number New Jersey REMEDIAL DRIVER EDUCATION PROGRAM INITIAL INSTRUCTOR LICENSE APPLICATION Official Use Only P.O. Box 170 Trenton, New Jersey 08666-0170 (609) 292-6500 ext.5094

More information

B POST Application Fee Log Avery. D. Niles, Commissioner

B POST Application Fee Log Avery. D. Niles, Commissioner GEORGIA DEPARTMENT OF JUVENILE JUSTICE Applicability: { } All DJJ Staff {x} Administration { x} Community Services {x} Secure Facilities (RYDC s and YDC s) Chapter 3: Effective Date: 7/15/16 Subject: FOR

More information

Waccamaw Economic Opportunity Council, Inc Highway 501 East, Suite B, Conway, SC 29526

Waccamaw Economic Opportunity Council, Inc Highway 501 East, Suite B, Conway, SC 29526 Waccamaw Economic Opportunity Council, Inc. 1261 Highway 501 East, Suite B, Conway, SC 29526 The Community Action Agency serving Horry, Georgetown and Williamsburg Counties EMPLOYMENT APPLICATION (WE ARE

More information

PRELICENSURE BSN PROGRAM OF STUDY APPLICATION PROCESS STUDENT CHECKLIST

PRELICENSURE BSN PROGRAM OF STUDY APPLICATION PROCESS STUDENT CHECKLIST APPLICATION DEADLINE for 2018 FALL SEMESTER PRIORITY ADMISSION: 2/15/2018 PRELICENSURE BSN PROGRAM OF STUDY APPLICATION PROCESS STUDENT CHECKLIST INSTRUCTIONS: Use this checklist to be sure you have included

More information

Initial Application Letter of Instruction

Initial 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

WSC Project Guide To National Service Criminal History Checks (NSCHC)

WSC Project Guide To National Service Criminal History Checks (NSCHC) WSC Project Guide To National Service Criminal History Checks (NSCHC) 1 Rev. 06/15/2018 Contents Section Page Introduction 3 What is Required to Complete the NSCHC? 4 What to Do With NSCHC Documents 5

More information

This is a Legal Document. By completing and signing this, you certify under

This is a Legal Document. By completing and signing this, you certify under APPLICATION FOR WYOMING REGISTERED NURSE LICENSURE with ADVANCE PRACTICE RECOGNITION (APRN) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this,

More information

CAMDEN COUNTY SHERIFF S OFFICE

CAMDEN COUNTY SHERIFF S OFFICE Position: Date: JAMES K. PROCTOR, SHERIFF CAMDEN COUNTY P.O. BOX 699 209 E. 4 TH STREET WOODBINE, GEORGIA 31569 Phone (912) 510-5100 CAMDEN COUNTY SHERIFF S OFFICE EMPLOYMENT APPLICATION Thank you for

More information

Professional Credential Services, Inc.

Professional Credential Services, Inc. Professional Credential Services, Inc. P.O. Box 198689 - Nashville, TN 37219-8689 www.pcshq.com Examination & Licensure Application for Physical Therapists For the Massachusetts Board of Allied Health

More information

Application Deadline for the Nursing Program is February 1, 2018 for Fall 2018 Admission. Turn in to Room 110-H between the hours of 8:30-4:00pm.

Application Deadline for the Nursing Program is February 1, 2018 for Fall 2018 Admission. Turn in to Room 110-H between the hours of 8:30-4:00pm. Application Deadline for the Nursing Program is February 1, 2018 for Fall 2018 Admission. Turn in to Room 110-H between the hours of 8:30-4:00pm. Your BVCTC # will become your ID throughout this process.

More information

APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify under

More information

EMPLOYMENT PROCEDURES FOR PARAPROFESSIONAL STAFF

EMPLOYMENT PROCEDURES FOR PARAPROFESSIONAL STAFF EMPLOYMENT PROCEDURES FOR PARAPROFESSIONAL STAFF PHASE I 1. Secure application form in person, mail, telephone, or website (www.pittsville.k12.wi.us). 2. Return the completed application form with a copy

More information

APPLICATION INSTRUCTIONS FOR INITIAL LICENSURE BY EXAMINATION FOR REGISTERED NURSES GENERAL INFORMATION

APPLICATION INSTRUCTIONS FOR INITIAL LICENSURE BY EXAMINATION FOR REGISTERED NURSES GENERAL INFORMATION LOUISIANA STATE BOARD OF NURSING 17373 Perkins Road. BATON ROUGE, LOUISIANA 70810 PHONE: 225-755-7500 FACSIMILE: 225-755-7580 Email: lsbn@lsbn.state.la.us APPLICATION INSTRUCTIONS FOR INITIAL LICENSURE

More information

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this, you certify under penalty of

More information

Public Safety Telecommunicator Class REGISTRATION FORM

Public Safety Telecommunicator Class REGISTRATION FORM Plea s e Visit U s On The W eb To Print Co u po n s Th at S a ve Yo u E ven More Money$ On Th e B est Ho m e I mp ro v ement Ser vices Atl anta! SOUTHEASTERN NEW MEXICO LAW ENFORCEMENT ACADEMY #1 Thunderbird

More information

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify, under

More information

MAINE STATE BOARD OF NURSING

MAINE STATE BOARD OF NURSING MAINE STATE BOARD OF NURSING 158 STATE HOUSE STATION 161 CAPITOL STREET AUGUSTA, MAINE 04333-0158 (207) 287-1138 APPLICATION FOR LICENSE AS A CERTIFIED REGISTERED NURSE ANESTHETIST Application Received

More information

Professional Credential Services, Inc.

Professional Credential Services, Inc. Professional Credential Services, Inc. P.O. Box 198689 - Nashville, TN 37219-8689 www.pcshq.com Licensure Application for Athletic Trainers For the Massachusetts Board of Allied Health Professionals If

More information

Professional Credential Services, Inc.

Professional Credential Services, Inc. Professional Credential Services, Inc. P.O. Box 198689 - Nashville, TN 37219-8689 www.pcshq.com Examination & Licensure Application for Physical Therapist Assistants For the Massachusetts Board of Allied

More information

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement)

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement) To: Employees with Conditional Offers of Employment Re: Background Checks All offers of employment or participation in any activity involving minors in a University sponsored program with The University

More information

CRIMINAL BACKGROUND CHECK by Division of Criminal Investigation (DCI)

CRIMINAL BACKGROUND CHECK by Division of Criminal Investigation (DCI) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify, under penalty of perjury and subject to the provisions of Wyo. Stat.

More information

APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify under

More information

SCHOOL BUS DRIVER APPLICATION

SCHOOL BUS DRIVER APPLICATION SCHOOL BUS DRIVER APPLICATION SCHOOL CITY OF HOBART SERVICE CENTER 200 SOUTH HOBART ROAD HOBART, INDIANA 46342 Social Security # Contact Phone # Name (Last) (First) (Middle) Permanent Address (Street)

More information

Jefferson County Sheriff s Office 200 Courthouse Way, Rigby, ID PH# ~ FX#

Jefferson County Sheriff s Office 200 Courthouse Way, Rigby, ID PH# ~ FX# Jefferson County Sheriff s Office 200 Courthouse Way, Rigby, ID 83442 PH# 208-745-9210 ~ FX# 208-745-9212 JOB APPLICATION Name: Application Date POSITION APPLIED FOR: Patrol Jail Dispatch Reserve Application

More information

Thank you for your interest in Tropic Ocean Airways.

Thank you for your interest in Tropic Ocean Airways. Thank you for your interest in Tropic Ocean Airways. Please complete the attached application, scan and return to us as soon as possible. If you are a Military Veteran (thank you for your service), please

More information

Professional Credential Services, Inc.

Professional Credential Services, Inc. Professional Credential Services, Inc. P.O. Box 198689 - Nashville, TN 37219-8689 www.pcshq.com Examination & Licensure Application for Physical Therapist For the Massachusetts Board of Allied Health Professionals

More information

Diocese of San Jose Personnel Department School Year. Dear Teacher Applicant:

Diocese of San Jose Personnel Department School Year. Dear Teacher Applicant: Diocese of San Jose Personnel Department 1999-2000 School Year Dear Teacher Applicant: Thank you for expressing interest in employment with the Diocese of San Jose. We want to be able to give the principals

More information

VILLAGE OF SOUTH ELGIN APPLICATION FOR LIQUOR LICENSE FOR INDIVIDUALS AND NON-INCORPORATED ENTITIES

VILLAGE OF SOUTH ELGIN APPLICATION FOR LIQUOR LICENSE FOR INDIVIDUALS AND NON-INCORPORATED ENTITIES VILLAGE OF SOUTH ELGIN APPLICATION FOR LIQUOR LICENSE FOR INDIVIDUALS AND NON-INCORPORATED ENTITIES To: Local Liquor Commissioner, Village of South Elgin Pursuant to the provisions of Title XI, Chapter

More information

APPLICATION FOR WYOMING LICENSED REGISTERED NURSE with ADVANCE PRACTICE RECOGNITION *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING LICENSED REGISTERED NURSE with ADVANCE PRACTICE RECOGNITION *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING LICENSED REGISTERED NURSE with ADVANCE PRACTICE RECOGNITION *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document,

More information

This is a Legal Document. By completing and signing this you certify under

This is a Legal Document. By completing and signing this you certify under APPLICATION FOR WYOMING LICENSED PRACTICAL NURSE (LPN) LICENSURE BY ENDORSEMENT *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this you certify

More information

APPLICATION FOR ADMISSION

APPLICATION FOR ADMISSION APPLICATION FOR ADMISSION UPMC SCHOOLS OF NURSING APPLICATION FOR ADMISSION The following schools are part of the UPMC Schools of Nursing. Please list in order of preference which school of nursing you

More information

Board Certification in Family Medicine Obstetrics

Board Certification in Family Medicine Obstetrics Board Certification in Family Medicine Obstetrics Application for Recertification The American Board of Physician Specialties (ABPS) is the official certifying body of the American Association of Physician

More information

Criminal Justice Selection Center

Criminal Justice Selection Center Criminal Justice Selection Center Thank you for your interest in the Florida Department of Law Enforcement (FDLE) Equivalency of Training Evaluation process for Out of State and Federal Officers. A person

More information

Signature: Signed by GNT Date Signed: 5/8/13

Signature: Signed by GNT Date Signed: 5/8/13 Atlanta Police Department Policy Manual Standard Operating Procedure Effective Date: April 15, 2013 Oath of Office and Law Enforcement Code of Ethics Applicable To: All employees Approval Authority: Chief

More information

Samuel P Harn Museum of Art Internship Application Form

Samuel P Harn Museum of Art Internship Application Form Samuel P Harn Museum of Art Internship Application Form Please type or print clearly in blue or black ink and answer all questions completely. Include additional sheets if necessary. First Name Last Name

More information

DEPUTY CHIEF HUNTLEY FIRE PROTECTION DISTRICT CORAL AVENUE HUNTLEY, ILLINOIS PHONE: (847)

DEPUTY CHIEF HUNTLEY FIRE PROTECTION DISTRICT CORAL AVENUE HUNTLEY, ILLINOIS PHONE: (847) DEPUTY CHIEF 2015 HUNTLEY FIRE PROTECTION DISTRICT 11808 CORAL AVENUE HUNTLEY, ILLINOIS 60142 PHONE: (847)669-5066 E-Mail: kcaudle@huntleyfpd.org Deputy Chief of Administration Huntley Fire Protection

More information

This is a Legal Document. By completing and signing, this you certify under

This is a Legal Document. By completing and signing, this you certify under APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION BY ENDORSEMENT, DEEMING, or RECERTIFICATION All certificates expire December 31 of every EVEN year This is a Legal Document. By completing and signing,

More information

MAINE STATE BOARD OF NURSING

MAINE STATE BOARD OF NURSING MAINE STATE BOARD OF NURSING 158 STATE HOUSE STATION 161 CAPITOL STREET AUGUSTA, MAINE 04333-0158 (207) 287-1138 APPLICATION FOR LICENSE AS A CERTIFIED NURSE-MIDWIFE Application Received Fee: CC Cash Check

More information

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify, under

More information

NAVAJO TECHNICAL UNIVERSITY Human Resources Department PO Box 849 Crownpoint, NM / 4109

NAVAJO TECHNICAL UNIVERSITY Human Resources Department PO Box 849 Crownpoint, NM / 4109 Applicant Name Vacancy Title NAVAJO TECHNICAL UNIVERSITY Human Resources Department PO Box 849 Crownpoint, NM 87313 505.786.4114 / 4109 is committed to enhancing the diversity of the University faculty

More information

VOLUNTEER APPLICATION PLEASE PRINT CLEARLY

VOLUNTEER APPLICATION PLEASE PRINT CLEARLY VOLUNTEER APPLICATION PLEASE PRINT CLEARLY Parish Name: Presentation Location: Upper Saddle River, NJ (Check one) Miss Ms. Mr. Today s Date: OFFICE USE ONLY: PDS V First Name: Middle: Last Name: Home Street

More information

APPLICATION FOR WYOMING LICENSED REGISTERED NURSE (RN) *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING LICENSED REGISTERED NURSE (RN) *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING LICENSED REGISTERED NURSE (RN) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify under penalty

More information

INFORMATION REGARDING NURSE LICENSURE BY EXAMINATION FOR GRADUATES OF FOREIGN NURSING PROGRAMS

INFORMATION REGARDING NURSE LICENSURE BY EXAMINATION FOR GRADUATES OF FOREIGN NURSING PROGRAMS New Jersey Office of the Attorney General Division of Consumer Affairs New Jersey Board of Nursing 124 Halsey Street, 6th Floor, P.O. Box 45010 Newark, New Jersey 07101 (973) 504-6430 www.njconsumeraffairs.gov/medical/nursing.htm

More information

STATE CERTIFICATION APPLICATION

STATE CERTIFICATION APPLICATION GEORGIA FIREFIGHTER STANDARDS AND TRAINING COUNCIL STATE CERTIFICATION APPLICATION Candidate Name GFSTC ID# TO BE MAINTAINED LOCALLY BY FIRE DEPARTMENT/AGENCY AND AVAILABLE FORE REVIEW BY GFSTC STAFF O.C.G.A.

More information

GLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER

GLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER 100 Sulphur Springs Road Brunswick, GA 31520 Telephone: (912) 554-7600 Web Page Address: www.glynncountysheriff.org INSTRUCTIONS AND INFORMATION PLEASE READ CAREFULLY BEFORE BEGINNING 1. Please complete

More information

New Jersey Motor Vehicle Commission

New Jersey Motor Vehicle Commission New Jersey STATE OF NEW JERSEY P.O. Box 170 Trenton, New Jersey 08666-0170 (609) 292-6500 ext. 5014 FAX# 609-292-4400 mvcblsprocessing@mvc.nj.gov Chris Christie Governor Kim Guadagno Lt. Governor Raymond

More information

Instructions for Filing the Raffle Report of Operations for Non-Draw Raffles (Carnival Games and Wheels)

Instructions for Filing the Raffle Report of Operations for Non-Draw Raffles (Carnival Games and Wheels) New Jersey Office of Attorney General Division of Consumer Affairs Legalized Games of Chance Control Commission 124 Halsey Street, 6th Floor, P.O. Box 46000 Newark, New Jersey 07101 (973) 273-8000 Instructions

More information

NURSING PROGRAM APPLICATION PACKET APPLICATION DEADLINE: FEBRUARY 15, :00 PM

NURSING PROGRAM APPLICATION PACKET APPLICATION DEADLINE: FEBRUARY 15, :00 PM Name: Nursing Program P.O. Box 610 Holbrook, AZ 86025 (928) 532-6136 NURSING PROGRAM APPLICATION PACKET APPLICATION DEADLINE: FEBRUARY 15, 2017 4:00 PM Date: Thank you for your interest in the Northland

More information

You may hold only ONE multistate license, issued from the state where you reside.

You may hold only ONE multistate license, issued from the state where you reside. APPLICATION FOR WYOMING LICENSED REGISTERED NURSE (RN) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify, under penalty

More information

LOS BANOS POLICE DEPARTMENT VITAL APPLICATION PACKET TH Street Los Banos, CA Telephone (209) Fax (209)

LOS BANOS POLICE DEPARTMENT VITAL APPLICATION PACKET TH Street Los Banos, CA Telephone (209) Fax (209) Thank you for your interest in becoming part of the Los Banos Police Department VITAL Volunteer Program. The VITAL Volunteer Program provides Los Banos residents the opportunity to provide input and have

More information

CITY OF SLAYTON Application for Police Service APPENDIX A

CITY OF SLAYTON Application for Police Service APPENDIX A CITY OF SLAYTON Application for Police Service APPENDIX A Directions: 1. PRINT clearly and give complete and accurate information. If you do not, you may be removed from further consideration. USE BLACK

More information

COMMISSIONED SECURITY OFFICER APPLICATION

COMMISSIONED SECURITY OFFICER APPLICATION COMMISSIONED SECURITY OFFICER APPLICATION FOR OFFICE USE ONLY EFFECTIVE 12-2016 EXPIRES PROCESSED BY NOTICE: Information contained on this application is considered a public record and may be released

More information

SHERIFF OF GARFIELD COUNTY LOU VALLARIO

SHERIFF OF GARFIELD COUNTY LOU VALLARIO SHERIFF OF GARFIELD COUNTY LOU VALLARIO 107 8 TH Street Glenwood Springs, CO 81601 Phone: 970-945-0453 Fax: 970-945-7700 106 County Road 333-A Rifle, CO 81650 Phone: 970-665-0200 Fax: 970-665-0253 Dear

More information

This package is meant to be used simply as a guide. The State Legalized Games of Chance has full authority over games of chance.

This package is meant to be used simply as a guide. The State Legalized Games of Chance has full authority over games of chance. Township of Washington Township Clerk s Office 523 Egg Harbor Road Sewell, NJ 08080 856-589-0520 Ext. 213 lselb@twp.washington.nj.us RAFFLES This packet has been designed to assist registered organizations

More information

INFORMATION CERTIFICATION

INFORMATION CERTIFICATION INFORMATION CERTIFICATION This form is required for employment. Please print or type and ensure all information is provided as omissions can delay processing. After acceptance of employment, applicants

More information

Application for Certification as a Groundwater Professional National Ground Water Association

Application for Certification as a Groundwater Professional National Ground Water Association Requirements for Candidacy for Certification as a Certified Groundwater Professional Applicants must have at least 12 months professional experience in the groundwater industry and a bachelor s degree

More information

VOLUNTEER FIREFIGHTER APPLICATION

VOLUNTEER FIREFIGHTER APPLICATION GEORGIA FIREFIGHTER STANDARDS AND TRAINING COUNCIL VOLUNTEER FIREFIGHTER APPLICATION Candidate Name GFSTC ID# TO BE MAINTAINED LOCALLY BY FIRE DEPARTMENT/AGENCY AND AVAILABLE FORE REVIEW BY GFSTC STAFF

More information

NON-TEACHING APPLICATION

NON-TEACHING APPLICATION WA-NEE COMMUNITY SCHOOLS 1300 North Main Street Nappanee, IN 46550-1015 For Office Use Only Interview (date & time) Reference Check Expanded Criminal Background Check Drug Test Sexual Offender Check CPS

More information

PLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date:

PLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date: Name: Previous Name/s: Home Phone No: Work Phone No: E-mail: What class of Administrative Certificate do you hold? PLEASE TYPE OR PRINT CLEARLY USING A PEN Today s Date: If you do not possess an administrative

More information

Florida Department of Corrections CORRECTIONAL PROBATION OFFICER SUPPLEMENTAL APPLICATION

Florida Department of Corrections CORRECTIONAL PROBATION OFFICER SUPPLEMENTAL APPLICATION Florida Department of Corrections CORRECTIONAL PROBATION OFFICER SUPPLEMENTAL APPLICATION Applicant's Name: Social Security #: Date of Birth: / / Race/Ethnicity: Gender: Female Male Your legal name, social

More information

OFFICE OF MEMBERSHIP COMMITTEE

OFFICE OF MEMBERSHIP COMMITTEE Dear Prospective Member, Thank you for your interest in becoming a member of the Mohegan Volunteer Fire Association (MVFA). Few jobs offer you the opportunity to save a life, but as a volunteer firefighter

More information

VALLEY COUNTY SHERIFF S OFFICE

VALLEY COUNTY SHERIFF S OFFICE VALLEY COUNTY SHERIFF S OFFICE SHERIFF PATTI BOLEN 107 W. SPRING STREET P.O. BOX 1350 CASCADE, ID 83611 208-382-7150 208-382-7170 fax Valley County Sheriff Hiring Standards Valley County strives to hire

More information

Jean Monestime Miami-Dade County Commissioner, District 2 Mom And Pop Small Business Grant Program

Jean Monestime Miami-Dade County Commissioner, District 2 Mom And Pop Small Business Grant Program Jean Monestime Miami-Dade County Commissioner, District 2 Mom And Pop Small Business Grant Program Application Please submit 1 original completed application marked ORIGINAL and 1 copy completed application

More information

CANDIDATE APPLICATION FOR PARAMEDIC STUDENT SPONSORSHIP

CANDIDATE APPLICATION FOR PARAMEDIC STUDENT SPONSORSHIP INSTRUCTIONS FOR COMPLETION CANDIDATE APPLICATION FOR PARAMEDIC STUDENT SPONSORSHIP 1. The application must be completed in its entirety prior to submission. 2. All signatures and dates required must be

More information

CITY OF BRANDON POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT. ALL applicants MUST attach items 1, 2, 3, 4 I. PERSONAL HISTORY

CITY OF BRANDON POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT. ALL applicants MUST attach items 1, 2, 3, 4 I. PERSONAL HISTORY CITY OF BRANDON POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT MAIL OR DELIVER TO: THE CITY OF BRANDON 1000 MUNICIPAL DRIVE P.O. BOX 1539 BRANDON, MS 39043 ATTN: PERSONNEL Date: Notice: Application MUST

More information