Be Completed By The Applicant
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Information for Agency Information for Applicant
www.opm.govTo be completed by the employing agency personnel office of the deceased. Section 3: Health Benefits Election To be completed by the employing agency personnel office of the deceased and the applicant, if appropriate. Section 4: Information and Elections Regarding Post-1956 Military Service To be completed by applicant, if appropriate.
INFORMATION ABOUT CALIFORNIA CHILDREN’S SERVICES …
www.dhcs.ca.govThis application is to be completed by the parent, legal guardian, or applicant (if age 18 or older, or an emancipated minor) in order to determine if the applicant is eligible for CCS services/benefits. The term "applicant" means the child, individual age 18 or older, or emancipated minor for whom the services are being requested.
SECTION A - TO BE COMPLETED BY APPLICANT
www.nibtt.netsection "a" - to be completed by applicant ni 82 yyyy mm dd surname other name(s) (street) (city/district/county) 8. marital status: single married widowed divorced 9. state maiden name (where applicable): surname 12. last employer registration no: (if known) 13. employment record from 10 april, 1972. name of employer address of employer period of
PAUL D. PATE Application for - Iowa
sos.iowa.govIf “Yes”, applicant must also submit to the Secretary of State a completed Application for Approval to Perform 7. Remote Notarizations - Effective July 1, 2020: Check box to indicate whether applicant intends to perform notarial acts for remotely
N-648, Medical Certification for Disability Exceptions
www.uscis.govDec 31, 2021 · Part 1. Applicant Information . 1. Applicant's Other Information. 3. Please read the instructions before examining the applicant and filling out this form. If you are using an interpreter during the examination (either in person or by phone), you must ask the interpreter the following questions and affirm their response:
Checklist: Licensed Mental Health Counselor
www.op.nysed.govForm 4. Applicant Experience Record of supervisor(s) submitting verification of at least 3,000 hours of supervised experience in mental health counseling & psychotherapy in NY or another jurisdiction**** Form 4B. Certification of Experience for LMHC. Form must be submitted directly by the supervisor. **** Form 4E.