U.S. Coast Guard Auxiliary Enrollment Application Procedure ANSC

Size: px
Start display at page:

Download "U.S. Coast Guard Auxiliary Enrollment Application Procedure ANSC"

Transcription

1 U.S. Coast Guard Auxiliary Enrollment Application Procedure ANSC PLEASE MUTE YOURSELF IF YOU WISH TO SPEAK, SEND ME A CHAT TO BE RECOGNIZED. THIS WILL ELIMINATE EVERYONE SPEAKING AT ONCE. THANK YOU Everyone requesting membership in the U.S. Coast Guard Auxiliary must complete this form.

2 ENTER FULL LEGAL NAME AS PER OFFICIAL DOCUMENTS SUBMITTED NO INITIALS NO MIDDLE NAME (NMN) -- MM/DD/YY NO NICKNAMES USE CURRENT ADDRESS NO P.O. BO WILL BE ACCEPTED PAGE 12 OF PACKET ENTER CITY WHERE ADDRESS IS LOCATED FL. 9 DIGIT CODE ENTER PRIMARY ADDRESS ENTER SECONDARY IF AVAILABLE OR N/A AREA CODE/NUMBER OR N/A AREA CODE/NUMBER OR N/A AREA CODE/NUMBER OR N/A AREA CODE/NUMBER OR N/A AREA CODE/NUMBER OR N/A AREA CODE/NUMBER OR N/A BRN BRN O POSITIVE/UNKN OFFICER OR MEMBER ENTER 6 DIGIT CODE SEE PGS on Form 7001 MUST BE SOMEONE NOT LIVING WITH APPLICANT AT THE SAME ADDRESS SUBMIT ANSWER SHEET SCORED SUBMIT COPY OF DD-214 BLUE INK NASBLA APPROVED COURSE ONLY TWO CARDS SIGNED IN BLACK INK NAME SUBMITTED MUST BE IDENTICAL TO PROOF OF CITIZENSHIP DOCUMENT Page 1

3 SIGN IN BLUE INK TO BE COMPLETED IF APPLICANT IS 17 YEARS OLD SIGNATURE IN BLUE INK AS PER DOCUMENT SUBMITED TO BE COMPLETED BY DIRAU If checked, MUST submit a DD-214 or the National Guard equivalent NGB-22, for each branch of service indicated. A letter stating the DD-214 was misplaced or lost will not suffice. A copy of the DD-214 can be obtained from the following sources: DD-214 MUST CONTAIN RE CODE A statement of specifics should be submitted with the New Member Application to include date, city and state of offense, disposition and any comments including mitigating circumstances, along with a copy of any court documents. Applicant may submit his statement in a sealed envelope for the attention of the Director of Auxiliary only. Page 2

4 EITHER BO MUST BE CHECKED SIGN IN BLUE INK SIGN IN BLUE INK CORRECT BO MUST BE CHECKED Yes must be checked to print Pages 6 thru 9 to provide additional information. Only applicable if a security clearance has been issued to the applicant by a federal agency within the past ten years. An additional document should be provided. IF AVAILABLE A COPY OF BACKGROUND INFORMATION SHOULD BE SUBMITTED Page 3

5 LEAVE BLANK NAME AS PER THE OFFICIAL DOCUMENT SUBMITTED JR./SR. NET TO MIDDLE NAME ALL NAMES - CURENT/FORMER USED MUST BE INDICATED DATES MUST BE SUBMITTED IF UNKNOWN ENTER DATE OF BIRTH TO PRESENT YEAR ONLY ACCEPTABLE Identify mother s maiden name with NEE. INCLUDE MIDDLE NAME Naturalized Citizens complete Sections 13a, 13b & 13c ONLY ACCEPTABLE GRAY AREA- 13a/13d CANADIAN CITIZENS MUST OBTAIN A CANADIAN RELEASE OF INFORMATION FORM FROM THE DDSL Page 4

6 SIGN IN BLUE INK MIDDLE NAME NO INITIALS ALL FORMER/CURRENT NAMES USED HOME/CELL Page 5

7 PRIOR/CURRENT INVESTIGATION INFORMATION COVER SHEET SIGN IN BLUE The investigation must have been within the past ten years. SF 86C (pages 7, 8 & 9) must be completed, signed, dated and attached to the cover sheet. Page 6

8 Page 7

9 Page 8

10 STANDARD FORM 86 CERTIFICATION (SF 86C) SIGNATURE IN BLUE Page 9

11 Fingerprint Card FD-258 All Revisions are Acceptable Page 10

12 Fingerprint Card SF-87 REVISION MARCH 2013 ONLY MUST BE THE IDENTIAL TO THOSE ON PAGE 1 Page 11

13 SAMPLE FINGERPRINTS Page 12

14 Coast Guard Auxiliary Association Form New Version 1 Page NEW VERSION CAN BE OBTAINED IN THE HR CORNER Page 13

15 FLOTILLA COMMANDER ATTESTATION FOR PROVISIONAL MEMBERSHIP ANSC 7068 TO BE COMPLETED BY THE FLOTILLA COMMANDER (FORM WILL BE SENT BY DIRAU WITH WELCOME PACKAGE) SUGGESTION SHOULD BE COMPLETED FIRST EPLANATION MUST BE SUBMITTED Page 14

16 (INSTRUCTIONS) Page 15

17 Welcome Letter Page 16

18 ENROLLMENT APPLICATION PROCEDURE THE ANSC 7001 (5-15) Two completed ANSC 7001 (5-15) Forms Page 1 Enter full middle name (no initials) if there is no middle name, indicate (NMN). If only a birth certificate is submitted, submit additional government photo ID. Page 2 If there is a conviction, official court documents and a personal explanation statement of the situation must be submitted. Completed Pages 1-5 or 1-9 (Security Issues) two complete sets must be submitted. Enrollment form should be filled out in black ink - all signatures must be in blue ink. Completed, scored New Member Exam Answer Sheet ANSC Two copies of document used for proof of citizenship. Two copies of DD-214 if applicable must contain RE Code Form Copy #4 Two fingerprint cards signed in black ink only Copy of Boating Safety Course Certificate NASBLA Approved Only CGAUA-INC-Consent Form March 14, 2014 Coast Guard Auxiliary Association, Inc Consent to Membership New Version HR Corner Photo of applicant either as paper photo or digital on CD. Photo must have red background and applicant should be wearing a light blue shirt. Include name of applicant and flotilla number on the photo or CD. A floppy disc will not be accepted. Use of staples on an application is not acceptable. No loose-leaf holed applications will be accepted. Applications should be printed on one side only. Two-sided copies are not acceptable. Passport copies must be submitted as a full page copy. ALL new member packages must be submitted to the FC for final signature and forwarded to the DDSL/ADDSL within the Division via hand delivery or certified mail. Once the member package is sent to the FC, the HR Department is no longer responsible for the processing. The processing is now the responsibility of the Security Department. After a month, if Member listed in AP Status or the Flotilla Commander did not receive the new Member Welcome Aboard Package and Certificate, an entry should be placed in the D7 Help Desk at New Enrollment Category. Page 17

New Member Enrollment and Support

New Member Enrollment and Support New Member Enrollment and Support 7-1-15 Only the (newest) ANCS 7001 (5-15) must be used. Complete pages 1-5. Two application are sent to DIRAUX. All signatures must be in blue ink. Enrollment forms are

More information

New Member Enrollment and Support

New Member Enrollment and Support New Member Enrollment and Support 3-1-14 Two (newest) Enrollment Applications (presently ANCS 7001 10-12). Two Fingerprint Cards. One New Member Course Examination answer sheet. (Form ANSC 7010) Coast

More information

Prospective Member Guide

Prospective Member Guide Prospective Member Guide BE PART OF THE ACTION! "TEAM COAST GUARD" United States Coast Guard Auxiliary 9 th. District, Eastern Region Division 03, Flotilla 02 Hamburg, NY 14059 www.wnyboatsafe.org 1 Table

More information

Italian Visa Requirements

Italian Visa Requirements Italian Visa Requirements International Programs - Florence Florence Academic Year 18-19 and Fall Only Students Students attending Florence, Italy for the Academic Year are required to have a student visa.

More information

FREQUENTLY ASKED QUESTIONS (FAQS) Personnel Security Investigations (PSI)

FREQUENTLY ASKED QUESTIONS (FAQS) Personnel Security Investigations (PSI) FAQ & Answers approved by CG-86, SECCEN, G-OCX, & Aux Leadership (NACO) FREQUENTLY ASKED QUESTIONS (FAQS) Personnel Security Investigations (PSI) (also see page w/ definitions) (last updated 3/26/09) QUESTION

More information

2018 SCHOLARSHIP APPLICATION Military Spouse

2018 SCHOLARSHIP APPLICATION Military Spouse ELIGIBILITY: 2018 SCHOLARSHIP APPLICATION Military Spouse To be eligible for this scholarship program you must meet the following criteria: 1) Applicant must be the spouse of an Active Duty Navy, Marine

More information

INSTRUCTIONS FOR REQUESTING AN AFOSI LEOSA ID CARD Updated: 1 February 2018

INSTRUCTIONS FOR REQUESTING AN AFOSI LEOSA ID CARD Updated: 1 February 2018 INSTRUCTIONS FOR REQUESTING AN AFOSI LEOSA ID CARD Updated: 1 February 2018 As of February 2016, we no longer require weapons qualification documents for LEOSA ID packages. These instructions have been

More information

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL APPLICATION FOR CERTIFICATION This application complies with the requirements of O.C.G.A. 35-8-7.1, 35-8- 8, and 35-8-10. Failure to complete all portions

More information

Hampton Division of Fire and Rescue & Newport News Fire Department CANDIDATE BACKGROUND INFORMATION PACKET

Hampton Division of Fire and Rescue & Newport News Fire Department CANDIDATE BACKGROUND INFORMATION PACKET Hampton Division of Fire and Rescue & Newport News Fire Department CANDIDATE BACKGROUND INFORMATION PACKET ** This packet along with the required documents listed on the next page MUST be submitted on

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

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

Applicant Information

Applicant Information POSITION APPLIED FOR: DATE City of Coos Bay at your service Applicant Information NAME Last First Middle ADDRESS CITY STATE ZIP TELEPHONE Home Message Work Cellular Best time to call: At work At home May

More information

PHYSICIAN ASSISTANT LICENSURE INFORMATION PACKET

PHYSICIAN ASSISTANT LICENSURE INFORMATION PACKET ARKANSAS STATE MEDICAL BOARD LICENSURE DEPARTMENT 1401 W. Capitol Ave., Suite 340, Little Rock, AR 72201-2936 Phone (501) 296-1802 Fax (501) 296-1972 www.armedicalboard.org Emails with attachments must

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

Anderson County Sherif f s Department

Anderson County Sherif f s Department Anderson County Sherif f s Department The Robert Jolly Office Building 101 South Main Street, Suite 400 Clinton, Tennessee 37716 NOTICE: INCOMPLETE INFORMATION WILL RESULT IN THE DELAY OF THE PROCESSING

More information

PLYMOUTH POLICE DEPARTMENT POLICE OFFICER EMPLOYMENT POLICIES

PLYMOUTH POLICE DEPARTMENT POLICE OFFICER EMPLOYMENT POLICIES PLYMOUTH POLICE DEPARTMENT POLICE OFFICER EMPLOYMENT POLICIES REQUIREMENTS Must be a citizen of the United States of America Must be at least 21 and may not have reached your 36th birthday by date of appointment

More information

Auxiliary New Member Course

Auxiliary New Member Course Auxiliary New Member Course INSTRUCTOR GUIDE NOT FOR GENERAL DISTRIBUTION HR PERSONNEL ONLY PUBLISHED FOR EDUCATIONAL PURPOSES ONLY COMDTPUB P16794.39B 12/13/2010 NEW MEMBER COURSE - INSTRUCTOR GUIDE

More information

Guard Force International 7301 Ranch Rd N. 620 N. Suite 155 #284, Austin, TX 78726

Guard Force International 7301 Ranch Rd N. 620 N. Suite 155 #284, Austin, TX 78726 Guard Force International 7301 Ranch Rd N. 620 N. Suite 155 #284, Austin, TX 78726 Rev 4-2010 GFI Employment Form Received Applications will be active for 6 months Position applying for: Location: PERSONAL

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

Iowa Central Community College Health Science Office-Nursing Attention: Emily Holtapp One Triton Circle Fort Dodge, IA 50501

Iowa Central Community College Health Science Office-Nursing Attention: Emily Holtapp One Triton Circle Fort Dodge, IA 50501 Dear Advanced Standing Nursing student: Thank you for applying to the Advanced Standing Nursing program at Iowa Central Community College. In order to be considered for second level of the nursing program

More information

POLYTECHNICS MAURITIUS LTD

POLYTECHNICS MAURITIUS LTD Please complete all sections SECTION ONE: PREAMBLE NATIONAL DIPLOMA IN NURSING APPLICATION FORM You have taken an important step to submit an application for the National Diploma in Nursing at Polytechnics

More information

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL

GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL APPLICATION FOR PRE-SERVICE TRAINING Return to: GEORGIA PEACE OFFICER STANDARDS AND TRAINING COUNCIL P.O. Box 349 Clarkdale, Georgia 30111 FOREWORD

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 Occupational Therapists For the Massachusetts Board of Allied Health Professionals

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

March 5, Dear Senior High School Counselor / College & Career Advisor:

March 5, Dear Senior High School Counselor / College & Career Advisor: March 5, 2018 Dear Senior High School Counselor / College & Career Advisor: The Ivy and Pearls of Southern Maryland Community Charities in conjunction with Alpha Kappa Alpha Sorority, Inc., Nu Zeta Omega

More information

1. NAME Last First Middle 2. TITLE (e.g., M.D., LMFT) 3. SOCIAL SECUTIRY NO. 4. PERMANENT ADRESS STREET CITY STATE/COUNTRY ZIP CODE COUNTY

1. NAME Last First Middle 2. TITLE (e.g., M.D., LMFT) 3. SOCIAL SECUTIRY NO. 4. PERMANENT ADRESS STREET CITY STATE/COUNTRY ZIP CODE COUNTY Application for Certified Family Therapist USA and Canadian marriage and family therapy license holders. This application is specifically for licensed marriage and family therapist in the United States

More information

Quakertown Fire Company, Pittstown, NJ. Franklin Township Fire District No. 1 of Hunterdon County

Quakertown Fire Company, Pittstown, NJ. Franklin Township Fire District No. 1 of Hunterdon County Quakertown Fire Company, Pittstown, NJ Application for Active Membership Franklin Township Fire District No. 1 of Hunterdon County Release and Consent Form authorizing the Franklin Township Fire District

More information

Alabaster Legacy Scholarships Emerging Leader Network Scholarship

Alabaster Legacy Scholarships Emerging Leader Network Scholarship Alabaster Legacy Scholarships Scholarship Deadline May 1, 2017 Alabaster Legacy Scholarships The intent of this award is to encourage young women who are in pursuit of an education in preparation for vocational

More information

Alabaster Legacy Scholarships Bible College Scholarship

Alabaster Legacy Scholarships Bible College Scholarship Scholarship Deadline May 1, 2018 Women in Leadership The intent of this award is to empower women by providing funds for continued ministerial education. The goal of Women in Leadership is to enhance the

More information

NCLEX Examination RN NURSING LICENSURE PREPARATION SPRING 2018

NCLEX Examination RN NURSING LICENSURE PREPARATION SPRING 2018 NCLEX Examination RN NURSING LICENSURE PREPARATION SPRING 2018 Application for Licensure All applicants are required to apply for Licensure online via BreEZE on the California Board of Registered Nursing

More information

APPLICATION FOR EMPLOYMENT VERONA POLICE DEPARTMENT 111 Lincoln Street Verona Wisconsin (608)

APPLICATION FOR EMPLOYMENT VERONA POLICE DEPARTMENT 111 Lincoln Street Verona Wisconsin (608) APPLICATION FOR EMPLOYMENT VERONA POLICE DEPARTMENT 111 Lincoln Street Verona Wisconsin 53593 (608) 845-7623 This application must be completely filled out and clearly printed in black ink or typewritten.

More information

SHERIFF A. LANE CRIBB

SHERIFF A. LANE CRIBB SHERIFF A. LANE CRIBB GEORGETOWN COUNTY SHERIFF S OFFICE APPLICANT DISQUALIFIERS You are applying for a position with the Georgetown County Sheriff s Office. It is the Policy of the Sheriff s Office to

More information

application to Katherine Gulotta at DEADLINE TO APPLY IS JANUARY 31. Date of Birth Place of Birth Gender

application to Katherine Gulotta at DEADLINE TO APPLY IS JANUARY 31. Date of Birth Place of Birth Gender Personal Information Name: Last First Middle List all other names you have used, including nicknames and maiden names. If you have ever used any legally changed name, please list the time period this occurred

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

MONROE COUNTY SHERIFF S OFFICE APPLICANT INFORMATION SUMMARY

MONROE COUNTY SHERIFF S OFFICE APPLICANT INFORMATION SUMMARY Name (print or type): Date Received Position Applied For: by MCSO: MONROE COUNTY SHERIFF S OFFICE APPLICANT INFORMATION SUMMARY INTEGRITY RESPECT SERVICE DIVERSITY HONOR STATEMENT OF EQUAL EMPLOYMENT OPPORTUNITY

More information

Changing Employers in the LCP OR Extending a Work Permit beyond Four Years in the LCP

Changing Employers in the LCP OR Extending a Work Permit beyond Four Years in the LCP Changing Employers in the LCP OR Extending a Work Permit beyond Four Years in the LCP This instruction sheet explains the law in general. It is not intended as legal advice for your particular problem.

More information

APPLICATION 1 First Application for Associate Level

APPLICATION 1 First Application for Associate Level Colorado Sex Offender Management Board (SOMB) APPLICATION 1 First Application for Associate Level for Placement on the Adult and/or Juvenile Provider List Treatment Provider and/or Evaluator Colorado Department

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

Peoria Heights Fire Department. Membership Application Packet

Peoria Heights Fire Department. Membership Application Packet Peoria Heights Fire Department Membership Application Packet Please turn in all completed applications in a sealed envelope to the Village Administration office during normal business hours, or mail to

More information

GUIDELINES TO BOARD CHIROPRACTIC ASSISTANT TRAINING PROGRAM FOR HIRING A CA APPLICANT/TRAINEE

GUIDELINES TO BOARD CHIROPRACTIC ASSISTANT TRAINING PROGRAM FOR HIRING A CA APPLICANT/TRAINEE MARYLAND BOARD OF CHIROPRACTIC & MASSAGE THERAPY EXAMINERS 4201 PATTERSON AVE., SUITE 301, BALTIMORE, MD 21215-2299 OFFICE: 410.764.4726 FAX: 410.358.1879 www.mdchiro.org Date: Original Program Revision-

More information

COUNTY OF SACRAMENTO Probation Department

COUNTY OF SACRAMENTO Probation Department COUNTY OF SACRAMENTO Probation Department 9750 BUSINESS PARK DRIVE, SUITE 220, SACRAMENTO, CALIFORNIA 95827 TELEPHONE (916) 875-0273 FAX (916) 875-0347 LEE SEALE CHIEF PROBATION OFFICER COUNTY PAROLE OFFICER

More information

CNA Course Snow College West Campus, Ephraim UT & Juab Campus

CNA Course Snow College West Campus, Ephraim UT & Juab Campus CNA Course Snow College West Campus, Ephraim UT & Juab Campus *If you have any questions or concerns or need assistance getting started PLEASE contact Jennifer Bushman! 1. Registration Form Fill out above

More information

SCHOLARSHIP PROGRAM CHARLES GALE MASONIC MEMORIAL SCHOLARSHIP WILLIAM H. UPTON NAVAL AND MILITARY LODGE # / 2009 ACADEMIC YEAR

SCHOLARSHIP PROGRAM CHARLES GALE MASONIC MEMORIAL SCHOLARSHIP WILLIAM H. UPTON NAVAL AND MILITARY LODGE # / 2009 ACADEMIC YEAR SCHOLARSHIP PROGRAM CHARLES GALE MASONIC MEMORIAL SCHOLARSHIP General Information: Students applying for this scholarship must be enrolled as full time students at Olympic College, and must be entering

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

INSTRUCTIONS AND INFORMATION APPLICATION FOR INITIAL NURSE LICENSURE BY EXAMINATION

INSTRUCTIONS AND INFORMATION APPLICATION FOR INITIAL NURSE LICENSURE BY EXAMINATION Revised April 4. 2016 The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Division of Health Professions Licensure Board of Registration in Nursing

More information

CITY OF PLANT CITY 302 W. REYNOLDS STREET P. O. BOX C PLANT CITY, FLORIDA PHONE (813)

CITY OF PLANT CITY 302 W. REYNOLDS STREET P. O. BOX C PLANT CITY, FLORIDA PHONE (813) CITY OF PLANT CITY 302 W. REYNOLDS STREET P. O. BOX C PLANT CITY, FLORIDA 33564 PHONE (813) 659-4200 DATE: Your application will be removed from active status one year from this date. Name: Position &

More information

Town of Billerica Police Department 6 Good Street Billerica, Ma (978) Fax (978)

Town of Billerica Police Department 6 Good Street Billerica, Ma (978) Fax (978) Town of Billerica Police Department 6 Good Street Billerica, Ma 01821 (978) 671-0900 Fax (978) 663-2392 www.billericapolice.org BILLERICA POLICE DEPARTMENT POLICE CANDIDATE APPLICATION FOR EMPLOYMENT In

More information

Education

Education 2017-18 AmeriCorps Cross Cultural Education Service Systems (ACCESS) Member Application AmeriCorps is NOT a job. AmeriCorps is a ONE YEAR COMMITMENT to LEARN, SERVE, and earn a SMALL MONTHLY STIPEND and

More information

Appendix F. Auxiliarist-of-the-Year and Commodore Greanoff Inspirational Leadership Award Nomination Package Formats

Appendix F. Auxiliarist-of-the-Year and Commodore Greanoff Inspirational Leadership Award Nomination Package Formats Appendix F. Auxiliarist-of-the-Year and Commodore Greanoff Inspirational Leadership Award Nomination Package Formats In this Appendix This appendix contains the following information: Topic See Page AUXOY

More information

Sheriff Wes Drury Scott County Sheriff s Office P.O. Box South New Madrid Street Benton, Missouri Phone: Fax:

Sheriff Wes Drury Scott County Sheriff s Office P.O. Box South New Madrid Street Benton, Missouri Phone: Fax: Sheriff Wes Drury Scott County Sheriff s Office P.O. Box 279 131 South New Madrid Street Benton, Missouri 63736 Phone: 573-545-3525 Fax: 573-545-3527 APPLICATION FOR EMPLOYMENT ALL POTENTIAL EMPLOYEES

More information

Southwest Florida Public Service Academy 4312 E. Michigan Ave. Ft. Myers FL Tel: (239) Fax: (239)

Southwest Florida Public Service Academy 4312 E. Michigan Ave. Ft. Myers FL Tel: (239) Fax: (239) Southwest Florida Public Service Academy 4312 E. Michigan Ave. Ft. Myers FL 33905 Tel: (239) 334-3897 Fax: (239) 334-8794 Todd Everly, Director Robert Martin III, Corrections Coordinator Jack Thomson,

More information

An Equal Opportunity Employer

An Equal Opportunity Employer Thank you for your interest in employment with the Winter Haven Fire Department (WHFD). This application must be either typed or printed in legible form. Non-legible applications will be returned. Applications

More information

Southeastern Arizona Contractors Association Scholarship Program Application

Southeastern Arizona Contractors Association Scholarship Program Application Southeastern Arizona Contractors Association Scholarship Program Application WHO MAY APPLY? You must have a high school diploma with a GPA of 3.0 or better, or a GED with a minimum score of 450 per section.

More information

North Carolina A&T State University Undergraduate Admissions Application Instructions

North Carolina A&T State University Undergraduate Admissions Application Instructions 1 North Carolina A&T State University Undergraduate Admissions Application Instructions Thank you for your interest in North Carolina A&T State University! Please complete the admissions application carefully,

More information

FORT PECK ASSINIBOINE & SIOUX TRIBES EMPLOYMENT APPLICATION

FORT PECK ASSINIBOINE & SIOUX TRIBES EMPLOYMENT APPLICATION FORT PECK ASSINIBOINE & SIOUX TRIBES EMPLOYMENT APPLICATION P.O. Box 1027 501 Medicine Bear Road Poplar, MT 59255 INSTRUCTIONS: Type or print clearly in dark ink. You must answer all questions completely

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

Training Opportunity!

Training Opportunity! Training Opportunity! Certified Nursing Assistant (CNA) & Home Health Aide (HHA) Certified Nursing Assistant & Home Health Aide Training is an excellent training opportunity for individuals interested

More information

RADIOLOGIST ASSISTANT LICENSURE INFORMATION PACKET

RADIOLOGIST ASSISTANT LICENSURE INFORMATION PACKET ARKANSAS STATE MEDICAL BOARD LICENSURE DEPARTMENT 1401 West Capitol, Suite 340, Little Rock, AR 72201 Phone (501) 296-1802 Fax (501) 296-1972 www.armedicalboard.org Emails with attachments must be sent

More information

The Grafton Kiwanis Club Scholarship

The Grafton Kiwanis Club Scholarship DEADLINE: APRIL 20, 2018 The Grafton Kiwanis Club Scholarship A 500 scholarship given to one Senior graduating from Grafton High School ANY APPLICATION THAT DOES NOT INCLUDE ALL REQUIRED DOCUMENTATION

More information

Summary Report for Individual Task 805B-79T-4410 Prepare Army National Guard Judge Advocate General Application Packet Status: Approved

Summary Report for Individual Task 805B-79T-4410 Prepare Army National Guard Judge Advocate General Application Packet Status: Approved Summary Report for Individual Task 805B-79T-4410 Prepare Army National Guard Judge Advocate General Application Packet Status: Approved Report Date: 29 Apr 2015 Distribution Restriction: Approved for public

More information

SHERIFF, OHIO COUNTY 51 Sixteenth Street, Wheeling, West Virginia Law Enforcement Records

SHERIFF, OHIO COUNTY 51 Sixteenth Street, Wheeling, West Virginia Law Enforcement Records SHERIFF, OHIO COUNTY 51 Sixteenth Street, Wheeling, West Virginia 26003 Law Enforcement 304-234-3680 Records 304-234-3792 Re: Sheriff s Office Applicants Chief Deputy Drage Flick Special Information The

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

RESPIRATORY THERAPY LICENSURE INFORMATION PACKET

RESPIRATORY THERAPY LICENSURE INFORMATION PACKET ARKANSAS STATE MEDICAL BOARD LICENSURE DEPARTMENT 1401 W. Capitol Ave., Suite 340, Little Rock, AR 72201 Phone (501) 296-1802 Fax (501) 296-1972 www.armedicalboard.org Emails with attachments must be sent

More information

Carefully read the following information, application instructions, and the NCLEX Candidate Bulletin prior to completing the enclosed application.

Carefully read the following information, application instructions, and the NCLEX Candidate Bulletin prior to completing the enclosed application. Executive Office of Health and Human Services Department of Public Health Bureau of Health Professions Licensure Board of Registration in Nursing www.mass.gov/dph/boards/rn The Commonwealth of Massachusetts

More information

2018 Graduating High School Senior Academic Achievement Scholarship Packet

2018 Graduating High School Senior Academic Achievement Scholarship Packet 2018 Graduating High School Senior Academic Achievement Scholarship Packet Sponsored by: The Eglin Spouses Club All applications must be postmarked NO LATER THAN Friday, 9 March 2018. (Note: Application

More information

2017 NOSC SCHOLARSHIP APPLICATION A High School Senior

2017 NOSC SCHOLARSHIP APPLICATION A High School Senior 2017 NOSC SCHOLARSHIP APPLICATION A High School Senior Naples Overseas Spouse Club (NOSC) scholarships are made possible through NOSC sponsored activities, such as the NOSC Thrift Store, in which volunteers

More information

FIREARMS TRAINING COURSE REQUIREMENTS TO OBTAIN A FIREARMS QUALIFICATION CARD

FIREARMS TRAINING COURSE REQUIREMENTS TO OBTAIN A FIREARMS QUALIFICATION CARD FIREARMS TRAINING COURSE REQUIREMENTS TO OBTAIN A FIREARMS QUALIFICATION CARD The California Private Security Industry is governed by laws enacted by the California Legislature and contained in the California

More information

Private Investigator and/or Security Guard Qualifying Agent Application

Private Investigator and/or Security Guard Qualifying Agent Application Vermont Secretary of State Office of Professional Regulation 89 Main Street, 3 rd Floor Montpelier VT 05620-3402 Kara Shangraw Licensing Board Specialist (802) 828-1134 kara.shangraw@sec.state.vt.us www.vtprofessionals.org

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

IOS - Recruitment and Testing Services

IOS - Recruitment and Testing Services Westchester Police Department Application Instructions Thank you for your interest in the Westchester Police Department. Please be sure to carefully review all application instructions and testing information.

More information

Cahokia Volunteer Fire Department. Application for Membership

Cahokia Volunteer Fire Department. Application for Membership Cahokia Volunteer Fire Department Application for Membership Minimum Requirements for Membership 1) Must be a resident within the residential boundaries for at least 6 months. 2) Must be a minimum age

More information

Application for Employment Police Cadet

Application for Employment Police Cadet Halton Regional Police Service Application for Employment Police Cadet Dear Applicant: Return application package with photocopies of the following documents if you have not already provided them: OACP

More information

2016 LPN Advanced Placement Application. For Fall 2017 Entry, Second Year, Nursing Program

2016 LPN Advanced Placement Application. For Fall 2017 Entry, Second Year, Nursing Program Umpqua Community College 2016 LPN Advanced Placement Application For Fall 2017 Entry, Second Year, Nursing Program Please email roger.sanchez@umpqua.edu to reserve a seat for the required Elsevier s HESI

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION Travis County Human Resources Management Department 1010 Lavaca Street, 2 nd Floor (corner of West 11th & Lavaca) www.co.travis.tx.us P.O. Box 1748 Austin, TX 78767 (512) 854-9165 Voice EMPLOYMENT APPLICATION

More information

Georgia Peace Officer Standards & Training Council CERTIFICATION OF CANDIDATE PAGE 1

Georgia Peace Officer Standards & Training Council CERTIFICATION OF CANDIDATE PAGE 1 CERTIFICATION OF CANDIDATE PAGE 1 Projected Academy: Projected Academy Start Date Notify POST via e-mail if actual start date is different from this projection. Candidate s Last Name Candidate s First

More information

Melbourne Beach Volunteer Fire Department FIREFIGHTER VOLUNTEER APPLICATION PACKAGE

Melbourne Beach Volunteer Fire Department FIREFIGHTER VOLUNTEER APPLICATION PACKAGE Melbourne Beach Volunteer Fire Department 507 Ocean Avenue Melbourne Beach, FL 32951 (321) 724-1736 FIREFIGHTER VOLUNTEER APPLICATION PACKAGE Thank you for your interest in the Melbourne Beach Volunteer

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

2018 Combined Scholarship Fund (CSF) Application

2018 Combined Scholarship Fund (CSF) Application 1 A. Applicant s Eligibility 1. The Combined Scholarship Fund of Greater Fort Riley, Inc. (CSF) will award scholarships to qualified military family member applicants who wish to further their education

More information

FIRE RECRUIT CIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS MINIMUM QUALIFICATIONS

FIRE RECRUIT CIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS MINIMUM QUALIFICATIONS >0?.\. CIVIL SERVICE COMMISSION CITY OF TYLER, TEXAS Announces an Examination for FIRE RECRUIT ANNOUNCEMENT OPENS: THURSDAY, JULY 19, 2018 AT 9:30 A.M. APPLICATION DEADLINE: FRIDAY, AUGUST l7, 2018 AT

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION EMPLOYMENT APPLICATION CITY OF TAMARAC HUMAN RESOURCES DEPARTMENT 7525 NW 88 th AVENUE TAMARAC, FLORIDA 33321 PHONE: (954) 597-3600 FAX: (954) 597-3610 JOB LINE: (954) 597-3615 E-mail hrapplications@tamarac.org

More information

ASPE WISCONSIN CHAPTER ENGINEERING SCHOLARSHIP

ASPE WISCONSIN CHAPTER ENGINEERING SCHOLARSHIP ASPE WISCONSIN CHAPTER ENGINEERING SCHOLARSHIP Description The ASPE Wisconsin Chapter, in an effort to promote the field of engineering, created the ASPE Wisconsin Chapter Engineering Scholarship to recognize

More information

OCCUPATIONAL THERAPY LICENSURE INFORMATION PACKET

OCCUPATIONAL THERAPY LICENSURE INFORMATION PACKET ARKANSAS STATE MEDICAL BOARD LICENSURE DEPARTMENT 1401 W. Capitol Ave., Suite 340, Little Rock, AR 72201 Phone (501) 296-1802 Fax (501) 296-1972 www.armedicalboard.org Emails with attachments must be sent

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

INTENT TO APPLY FOR PROVISIONAL PROVIDER LISTING VIA THE JUDICIAL RURAL INITIATIVE

INTENT TO APPLY FOR PROVISIONAL PROVIDER LISTING VIA THE JUDICIAL RURAL INITIATIVE INTENT TO APPLY FOR PROVISIONAL PROVIDER LISTING VIA THE JUDICIAL RURAL INITIATIVE COLORADO DOMESTIC VIOLENCE OFFENDER MANAGEMENT BOARD COLORADO DEPARTMENT OF PUBLIC SAFETY DIVISION OF CRIMINAL JUSTICE

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

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

SACRAMENTO COUNTY SHERIFF S DEPARTMENT SCOTT R. JONES Sheriff. Volunteer Packet

SACRAMENTO COUNTY SHERIFF S DEPARTMENT SCOTT R. JONES Sheriff. Volunteer Packet SCOTT R. JONES Sheriff Volunteer Packet VIPS (Volunteers In Partnership with the Sheriff) DART (Dive And Rescue Team) SAR (Search And Rescue) SHARP (Sheriff s Amateur Ham Radio Program) Sacramento Sheriff

More information

Employment Application Fulshear Simonton Fire Department

Employment Application Fulshear Simonton Fire Department Employment Application Please keep the following in mind while completing the application. 1. Please read each question and all instructions carefully while completing the application. Answer all questions

More information

APPLICATION FOR BURBANK SISTER CITY 2018 STUDENT EXCHANGE PROGRAM TO OTA, JAPAN

APPLICATION FOR BURBANK SISTER CITY 2018 STUDENT EXCHANGE PROGRAM TO OTA, JAPAN APPLICATION FOR BURBANK SISTER CITY 2018 STUDENT EXCHANGE PROGRAM TO OTA, JAPAN The cities of Ota, Japan and Burbank, California have successfully participated in a 2-week summer cultural student exchange

More information

State Center Community College District MADERA CENTER VOCATIONAL NURSING PROGRAM

State Center Community College District MADERA CENTER VOCATIONAL NURSING PROGRAM MADERA CENTER VOCATIONAL NURSING PROGRAM Applications are now being accepted. This information packet contains admission & application policies for ongoing admission to the vocational nursing program.

More information

Eighth Western Rivers. U. S. Coast Guard Auxiliary Officers & District Policies Guide. Revision

Eighth Western Rivers. U. S. Coast Guard Auxiliary Officers & District Policies Guide. Revision a. Eighth Western Rivers U. S. Coast Guard Auxiliary Officers & District Policies Guide Revision 2013.1 21 SEP 2012 (THIS PAGE LEFT BLANK) 16970 21 September 2012 From: Director of Auxiliary, Eighth Western

More information

DOCUMENT EVALUATION INFORMATION

DOCUMENT EVALUATION INFORMATION DOCUMENT EVALUATION INFORMATION REGISTRATION PROCEDURES FOR INTERNATIONAL PHARMACY GRADUATES This document summarizes information about certification and licensing in Canada for pharmacists. The role of

More information

BURLESON COUNTY SHERIFF S OFFICE

BURLESON COUNTY SHERIFF S OFFICE BURLESON COUNTY SHERIFF S OFFICE EMPLOYMENT APPLICATION DEPARTMENT USE ONLY APPLICANT: POSITION: DATE RECEIVED: INTERVIEW DATE: TIME: RATING: 1 2 3 4 5 6 7 8 9 10 AUTHORITY INSTRUCTIONS FOR APPLICATION

More information

AmeriCorps Application Packet

AmeriCorps Application Packet AmeriCorps Application Packet Dear Friend, Fill out the application to the best of your ability. Must be 18 years or older with a High School Diploma or GED to apply. Must be a U.S. Citizen or National

More information

FREE TRAINING CAREER SUPPORT SERVICES

FREE TRAINING CAREER SUPPORT SERVICES DOL H-1B Ready To W ork Grant FREE TRAINING CAREER SUPPORT SERVICES Upcoming Courses Will Include: Pr Funding for TWIC card is available Participating Partner CollegesTrainings Offered: CC RCrafts Project

More information

APPLICATION FOR BURGLAR ALARM LICENSE (IN ACCORDANCE WITH G.S. 74D) [Type or Print in Black Ink] 1. Name First Middle (Maiden) Last (Nickname)

APPLICATION FOR BURGLAR ALARM LICENSE (IN ACCORDANCE WITH G.S. 74D) [Type or Print in Black Ink] 1. Name First Middle (Maiden) Last (Nickname) NORTH CAROLINA ALARM SYSTEMS LICENSING BOARD 3101 Industrial Drive Suite 104 Raleigh, North Carolina 27609 Phone: (919) 788-5320 Fax: (919) 788-5365 E-Mail: PPSASL@ncdps.gov www.ncdps.gov/asl.aspx APPLICATION

More information

Upon your arrival to campus, it will be your responsibility to provide our office with the following:

Upon your arrival to campus, it will be your responsibility to provide our office with the following: Spring and Summer, 2018 Thank you for your interest in Skidmore College s summer programs. As an international student planning to participate in our summer program, you will be expected to have a student

More information

Maine Human Resources Office Technician Vacancy Announcement Guide

Maine Human Resources Office Technician Vacancy Announcement Guide Maine Human Resources Office Technician Vacancy Announcement Guide Background of the Technician Program. The Maine National Guard Technician Program is Federal Civil Service employment. Positions are available

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

RANDOLPH COUNTY SHERIFF S OFFICE. Sheriff Eddie L. Fairbanks APPLICANT'S BOOKLET

RANDOLPH COUNTY SHERIFF S OFFICE. Sheriff Eddie L. Fairbanks APPLICANT'S BOOKLET RANDOLPH COUNTY SHERIFF S OFFICE Sheriff Eddie L. Fairbanks APPLICANT'S BOOKLET 1 of 12 NDOLPH COUN RANDOLPH COUNTY SHERIFF'S OFFICE 216 Recreation Camp Road Cuthbert, GA 39840 SHERIFF EDDIE L. FAIRBANKS

More information