Transcription of GENERAL SUPERVISION EVALUATION FORM FOR …
{{id}} {{{paragraph}}}
Example: bachelor of science
GENERAL SUPERVISION EVALUATION FORM FOR …
OBLADC form 208 11/2012 1 GENERAL SUPERVISION EVALUATION form FOR DRUG AND ALCOHOL LICENSURE/CERTIFICATION ELIGIBILITY LADC - Typically 50 completed hours of educational SUPERVISION / 2000 completed hours of practice/work hours under SUPERVISION CADC - Typically 100 completed hours of educational SUPERVISION / 4000 completed hours of practice/work hours under SUPERVISION LADC/MH - Typically 50 completed hours of educational SUPERVISION / 2000 completed hours of practice/work hours under SUPERVISION PARTIAL SUPERVISION (Due to a change in status, change of SUPERVISION , change of employment): Number of completed hours of SUPERVISION this EVALUATION :_____ Hours to present date: _____ SUPERVISEE Other name(s) under which evaluations have been submitted Home Address - Street/City/State/Zip Home E-Mail Home Phone ( ) Employing Agency Position Position is: Full Time Part-Time: Number of hours per week: Agency Address Street/City/State/Zip Agency E-Mail Agency Phone ( ) SUPERVISOR License Number Job Title Agency Pho
OBLADC Form 208 11/2012 1 GENERAL SUPERVISION EVALUATION FORM FOR DRUG AND ALCOHOL LICENSURE/CERTIFICATION ELIGIBILITY LADC - Typically 50 completed hours of educational supervision / 2000 completed hours of practice/work hours under supervision CADC - Typically 100 completed hours of educational supervision / …
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document:
Related search queries
Skill Evaluation Sheets, Skill Evaluation Sheets Skill, SKILL, NFPA 1006 Skills Evaluation Check Sheet, NFPA 1006 Skills Evaluation Check Sheet Skill, COMMISSION ON FIRE PROTECTION PERSONNEL, COMMISSION ON FIRE PROTECTION PERSONNEL STANDARDS AND, Evaluation, Fire Apparatus Operator: Mobile Water Supply, MULTIPLE-POINT ROPE, Are The Instrument: Sensory, Are The Instrument: Sensory Evaluation Methods