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Lic 9215 form You must have an active criminal record clearance on file with the Department. If you do not have an active clearance on file you will be informed in writing on how to proceed. COMPLETE AND SUBMIT BOTH PAGES OF THIS APPLICATION LIC 9215 12/12 PAGE 1 OF 2 NAME Please print LAST FIRST MIDDLE 1. 744 P Street MS 9-14-47 Sacramento CA 95814 Date APPLICATION FOR ADMINISTRATOR RE-CERTIFICATION Certificate Effective Date Expiration Date Name Address City State Zip Code This letter is to notify you that the administrator certificate issued to you by the California Department of Social Services CDSS will expire in 90 days. In order to maintain compliance with the provisions of the Administrator Certification Program you are required to submit your renewal information and fee prior to the certificate expiration date. Please submit the following Copy of certificate s of completion of required continuing education* A total of 40 forty hours of continuing education is required if you are an Administrator for either a Residential Care Facility for the Elderly an Adult Residential Facility or a Group Home. If you are a Nursing Home Administrator 20 twenty hours of continuing education are required* Hours may be completed through any combination of courses provided by G CDSS approved Vendors. Department of Developmental Services and approved by the Regional Center for ARF and GH Accredited educational institutions and vendors approved by other California State Agencies provided such courses are consistent with the Core of Knowledge specified in Regulations. You must submit each course with certificate of completion and a description of the course s or it will be returned to you. If the course does not relate to the Core of Knowledge or is duplicative you have taken the identical course before it will not be credited toward the recertification requirement. Crisis Prevention Institute Inc* CPI Nonviolent Crisis Intervention training. Pocket size certificates must be accompanied with a letter from CPI approved by the Board of Behavioral Sciences. The refresher course s is not acceptable for CEUs. Processing fee of 100. If your certificate has expired and/or your application is deemed incomplete you will be required to pay an additional 200. Do you currently possess or have you previously held a license certification or other approval as a professional in a specified field If yes please indicate the type of license or certificate and license number s I Yes I No License Number individuals If yes please indicate the type of license or certificate and license number s Issuing Government Agency 3. Are you currently or were you previously employed by a licensed community care facility If yes please indicate the facility name s and license number s Facility Name 4. Have you been the subject of any administrative legal or other action involving licensure certification or other approvals as specified in 1 2 or 3 above If yes please explain and provide dates. If additional space is needed please attach to this application form* I declare under penalty of perjury that the foregoing information is true.

Ga uniform application DISADVANTAGED BUSINESS ENTERPRISE PROGRAM 49 C.F.R. PART 26 GEORGIA Uniform Certification Application Georgia Department of Transportation Equal Opportunity Division One Georgia Center 600 West Peachtree

Michigan licensed business ent... FIS 0202 (4/08) Office of Financial and Insurance Regulation Michigan Application for Resident Business Entity Insurance License (Please Print or Type) 1 FEIN 2 Business Entity Name 3 Incorporation/Formation

Instructions on city of miami... City of Miami Building Department Permit Application Job Location Folio Number: Job Address: Legal Address: Unit No: Commercial Owner Zip: Process #: Total Due Permit #: Owner Lessee Information Owner:

Tcpa building permit applicati... TOWNSHIP COOPERATIVE PLANNING ASSOCIATION -- BUILDING PERMIT APPLICATION NO. 4111 11 Avenue SW Room 10 Rochester, MN 55902 th -- TCPA -Address Phone: (507) 529-0774 Fax: (507) 281-6821 Township Job

Nyc special events permit appl... CITY OF ITHACA A great place to SPECIAL EVENT PERMIT APPLICATION INTRODUCTION A wide variety of special events and activities have chosen to make Ithaca their home due to its natural beauty, diverse

Fire service application form... Riverside County Fire Department 77933 Las Montanas Rd., Ste 201, Palm Desert, CA 92211 Ph. (760) 863-8886 Fax (760) 863-7072 Fire Protection Planning Section 2300 Market St., Ste 150 Riverside, CA

Bristol va fireworks permit ap... Bristol Virginia Tennessee Association of Realtors Chili Cook Off at Bristol Rhythm & Roots Reunion September 17, 2011 Cook Off Rules 1. Contestants must pre-register with BTVAR/BRRR by submission

Application real license form I understand that DMV will send this card to the address I maintain with the Department of State. I also understand that the license/registration with the Department of State. DMV ID // - // - // Date Signed 6 Association Statement I am sponsoring this application in accordance with the Real Property Law 441. DMV ID // - // - // Date Signed 6 Association Statement I am sponsoring this application in accordance with the Real Property Law 441. 1 d. Broker License/Unique ID number Broker Print Name Broker Signature Please remember to include with this application any required explanations and statements along with your application fee checks should be made payable to NYS Department of State. A salesperson cannot operate independently. Who must apply for a Real Estate Salesperson license Any person acting as a Real Estate Salesperson as described above is required by law to have a Real Estate Salesperson DOS-0022 INST Rev. 6/08 Who cannot apply for a Real Estate Salesperson license A person is ineligible to file this application if s/he is a member of the partnership or is an officer or owns voting stock in the corporation that is the sponsoring broker. Upon broker approval license will be generated by Licensing that week and mailed to the office location indicated on your application. All change of associations must be completed through the online system. If you have been previously working for another company the first step is to ensure that the previous broker has already performed a termination on you. Once the termination is complete your new representative broker should log in to their own personal online real estate account you with their company. Any omission inaccuracy or failure to make full disclosure in an application may be deemed sufficient reason to deny a license or could result in the suspension or revocation if one is issued. What is in this package This package includes all the information and forms you will need to apply for licensure as a Real Estate Salesperson in A completed application will include the application form the nonrefundable 50 application fee and the appropriate documentation as it applies. Once the termination is complete your new representative broker should log in to their own personal online real estate account you with their company. Your new broker will need your license number in order to perform the transaction. Why do I need to provide my e-mail address on the application Complete initial Salesperson application Change residence address Renew license Request duplicate license print Examination results Application status License status For further information pertaining to Licensing web based application procedures please refer to our Frequently Asked Questions on our website at www. 5 hours must include at least three hours of instruction pertaining to fair housing and/or discrimination in the sale or rental of real property or an interest in What are the fees terms of licensure 50 - two-year license 15 - written examination What forms of payment do you accept You may pay by check or money order made payable to the using the enclosed credit card authorization form. Do not PAGE 2 send cash. Application fees are nonrefundable. A 20 fee will be charged for any check returned by your bank. Do I need to complete the Child Support Statement section of the application Yes. Be sponsored by a NYS licensed real estate broker pass the NYS real estate salesperson examination What do I need to do before applying for my You must successfully complete a 75-hour New York State approved course of study and pass a qualifying written examination administered by the Department before applying for a license to operate as a Real Estate Salesperson in this state. If you have completed the 45-hour salesperson qualifying course prior to July 1 2008 you may complete the 30-hour successful completion of schooling you must have the Certification of Satisfactory Completion section of the application completed by the Department of State approved school coordinator or the signature of their authorized designee.

How fill tn employment applica... Return completed application to: STATE OF TENNESSEE EMPLOYMENT APPLICATION Department of Human Resources Applicant Services Division 505 Deaderick Street nd 2 Floor, James K. Polk Building Nashville,

Arkansas state board of cosmet... ARKANSAS DEPARTMENT OF HEALTH COSMETOLOGY SECTION 4815 West Markham, Slot 8 Little Rock, AR 72205 (501) 682-2168 INSTRUCTIONS: File this application when applying for a new establishment license.

California hazardous waste per... State of California California Environmental Protection Agency Department of Toxic Substances Control GISS, P.O Box 806 Sacramento CA 95812-0806 Information and Instructions for Obtaining a Permanent

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