BPO Vendor Packet. Please or fax your completed application back to ISGN:

Size: px
Start display at page:

Download "BPO Vendor Packet. Please or fax your completed application back to ISGN:"

Transcription

1 BPO Vendor Packet Thank you for your interest in becoming an ISGN Vendor Partner. Please complete the following documents so we may successfully set up your account: 1. Vendor Application 2. Affiliate Business Status 3. Privacy Policy 4. Electronic Fund Transfer Authorization 5. W9 click here to download 6. Criminal Background Check - The final document in this packet provides instructions for how to request a background check, in accordance with ISGN s vendor policy. Please or fax your completed application back to ISGN: isgnvm@isgn.com If you have any questions you may us at isgnvm@isgn.com or call Option 6.

2 ISGN BPO Vendor Application Please complete all information below for successful account setup. NAME: TITLE: COMPANY: ADDRESS1: ADDRESS2: CITY, ST ZIP: OFFICE PHONE: CELL PHONE: FAX: LICENSE # & STATE: How long have you been licensed to sell real estate? Are you a broker or an agent? Do you have access to local MLS? Do you have a computer with internet access? Do you have access to public records? Do you have a digital camera? Have you previously completed BPOs? How many? Do you understand that you cannot complete BPOs on properties in which you have an interest, financial or otherwise? Do you have current E & O insurance?

3 In addition, please provide the following: Current Criminal Background Check (CBC). We have partnered with Sterling to provide our vendors with a CBC at a discounted rate. Instructions to purchase a CBC through Sterling are attached to your application . A previous background check completed for another AMC or GSE may be provided if it was completed in the last three years, and includes a full local & federal check. Resume, if available Completed W-9 Business Diversity Questionnaire Copy of your current real estate license Signed Privacy Policy Coverage by County/Zip Code Please use the following grid to note all areas that you service, have sufficient market knowledge to provide a credible opinion of value, and are within a reasonable driving distance to perform inspections. Add the county name, and vertically list the zip codes you service within that county If you cover all of the zip codes in that county, then under zip codes write All COUNTIES ZIP ZIP ZIP ZIP ZIP ZIP ZIP ZIP Ex: Fulton Ex: Cobb All Please this application back to ISGN at isgnvm@isgn.com. If you have any questions you may us at the same address or call Option ISGN. All rights reserved. Confidential Page 2 of 2

4 ISGN Affiliate Business Status Purpose: This document is designed to gather on size and/or ownership by protected groups as defined by the U.S. Federal Government. This data is used only for after the fact reporting as required by ISGN contracts with certain clients that track the utilization of disadvantaged business groups. The information you provide is confidential and is not used as selection criteria. Completion: This document must be completed by the business owner and/or company officer. The questions apply only to the owner(s) of the business, not employees, agents or independent contractors. Please circle your answers. CITIZENSHIP Are you a citizen of the United States? Yes No SMALL BUSINESS To qualify as a Small Business, you cannot exceed the size limits set by the Small Business Administration (SBA): For Appraisal Offices, the SBA size limit is up to $1,500,000/year in gross income For Real Estate Brokerage, the SBA size limit is up to $1,500,000 in gross commissions For Attorney/Title/Closing Offices, the SBA size limit is up to $6,000,000 in total revenue Are you a Small Business as defined by the Small Business Administration? Yes No WOMAN-OWNED BUSINESS Is this business owned and controlled by a woman (or women, collectively) who owns at least 51% of the business? VETERAN-OWNED BUSINESS Is this business owned and controlled by a Veteran(s) who owns at least 51% of the business? Yes No SERVICE-DISABLED VETERAN-OWNED BUSINESS Is this business owned and controlled by a Service-Disabled Veteran(s) who owns at least 51% of the business? HISTORICALLY UNDERUTILIZED BUSINESS ZONE (HUBZONE) Is this business located in a Historically Underutilized Business Zone (chronic high unemployment, low income) as defined by the Small Business Administration? If yes, please attach a copy of your HUBZone certification. MINORITY-OWNED BUSINESS Is this business owned and controlled by a minority(s) that owns at least 51% of the business? If Yes, one or more of the following Minority Categories must be checked: African American: United States citizens whose origin is from any of the African racial groups Hispanic American: United States citizens whose origins are in Mexico, Puerto Rico, Cuba, Latin America, South America, Portugal or Spain Subcontinent Asian American: United States citizens whose origins are in India, Pakistan, Bangladesh, Sri Lanka, Bhutan or Nepal Native American: American Indians, Eskimos, Aleuts and native Hawaiians Asian- Pacific Americans: United States citizens whose origins are in the Philippines, Vietnam, Korea, Samoa, Guam, the U.S. trust Territory of the Pacific Islands (Republic of Palau), the Northern Mariana Islands, Laos, Kampuchea (Cambodia), Taiwan, Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Republic of the Marshall Islands or the Federated States of Micronesia Mixed Minority: All United States citizens who may fall into more than one of the above categories MINORITY-OWNED BUSINESS Yes Yes Yes Yes No No No No Do you hold a third party certification from an organization such as the NMSDC (National Minority Supplier Development Council) or the WBENC (Women s Business Enterprise National Council)? If Yes, please include a copy of your certificate with your response. Yes No

5 I CERTIFY THAT: 1) The business size and/or 2) The characteristics of the business ownership, as indicated above, are accurately reflected, and 3) All information supplied herein (including attachments, if any) is true and correct. COMPANY: ADDRESS1: ADDRESS2: CITY, ST ZIP: OFFICE PHONE: CELL PHONE: FAX: Contractor Signature Contractor Printed Name Contractor Title Name of Company (if applicable) Date Please this document with your application back to ISGN at If you have any questions you may us at the same address or call Option ISGN. All rights reserved. Confidential Page 2 of 2

6 ISGN Solutions, Inc. Privacy Policy This policy applies to all employees, consultants, and contractors who work for ISGN Solutions, Inc. (ISGN). The purpose of this policy is to set forth a program to prevent misuse of private information received from ISGN S customers and their respective borrowers. Private Nonpublic Information Privacy Protection Policy At ISGN, protecting the privacy and confidentiality of the personal information of our customers and their respective borrowers is important to us. We value the business and the trust that customers place with ISGN. In order to offer our products and services, we collect, maintain and use information about our customers and their respective borrowers on a routine basis. To help our employees, consultants, and contractors better understand how this information is protected, we are providing the following statement describing our practices and policies with respect to the privacy of customer information. ISGN, under no circumstances, sells private, nonpublic personal information to third parties. We do not disclose any private, nonpublic personal information on our current or former customers to any affiliated or nonaffiliated third party except as permitted by law. We may collect information volunteered by customers and their respective borrowers during the application process, and obtained from other authorized sources, such as credit bureaus. All information collected and stored by ISGN is used for specific business purposes, such as administering accounts, complying with state/federal regulations, protecting against fraud, and developing a better understanding of loan support services to provide improved products and services. We understand the protection of private, nonpublic personal information is of the utmost importance. Guarding our customers and their respective borrower's privacy is our obligation. ISGN maintains strict procedures and policies to safeguard this privacy. We restrict employee access to customer information to only those who have a business reason to know such information, and we educate our employees about the importance of confidentiality and customer privacy. Customer Information is defined as any personally identifiable information or records in any form (written, electronic or otherwise) relating to a customer or their respective borrower. This includes, but is not limited to: name, address, telephone number, loan number, loan payment history, delinquency status, insurance carrier or payment information, tax amount or payment information; the fact that the customer has a relationship with ISGN; or the fact that the Borrower has a relationship with Lender or any other personally identifiable information. Reporting Violations of This Policy Any employee, consultant or contractor who discovers a potential violation of this policy shall notify their supervisor or manager who will investigate the matter. All managers or supervisors must also contact Human Resources for assistance. Consequences of Policy Violation If, after an investigation of a potential violation of this policy, it is determined that an employee, contractor or consultant has violated this policy, the employee, contractor or consultant shall be subject to discipline, up to and including termination of employment or the termination of the contractor s or consultant s engagement. Right to Change Policy ISGN reserves the right to change this policy at any time without prior approval or notice. ISGN Distribution and Enforcement of Policy Employee Notification A copy of this Policy is given to all new employees along with all employees hired prior to the effective date of this policy. All employees shall be required to sign the Agreement Notice form. The signed form is placed in the employee s personnel file.

7 Consultant/Contractor Notification A copy of this policy is distributed via , fax or U.S. mail to all new consultants and/or contractors. The duly authorized signatory of all such consultants and/or contractors shall be required to sign the Agreement Notice form. No consultant and/or contractor may be permitted to perform any services and/or work on behalf of ISGN until such form is signed and has been received by ISGN. The signed form is placed for retention in the consultant or contractor s file. Responsible for Enforcement Human Resources is responsible for insuring all employees and consultants are provided a copy of this policy and for securing the duly authorized Agreement Notice form. The Affiliate Managers are responsible for insuring that all contractors are provided a copy of this policy and for securing the duly authorized Agreement Notice form. AGREEMENT NOTICE - Private Nonpublic Information Privacy Protection Policy As a contractor of ISGN Solutions, Inc. (ISGN), and or its branches and affiliates, I recognize and understand that any private, nonpublic information received from our customer(s) and/or client(s) is to be used solely for company business. I understand any dissemination of said private, nonpublic information may subject me to disciplinary action up to and including termination of my employment and/or termination of my engagement as a consultant or contract with ISGN. I acknowledge that I have read and that I understand the ISGN Private Nonpublic Information Privacy Protection Policy and the corresponding Agreement notice. Contractor Signature Contractor Printed Name Contractor Title Name of Company (if applicable) Date Please sign, scan and this document with your application back to ISGN at isgnvm@isgn.com. If you have any questions you may us at the same address or call Option ISGN. All rights reserved. Confidential Page 2 of 2

8 Electronic Fund Transfer Authorization Please complete form in black ink. (hereafter referred to as SELLER ) sells goods and/or services to ISGN and/or one or more of its wholly-owned subsidiaries. ISGN desires the flexibility to make payments for such goods and/or services by electronic funds transfer (EFT transactions) through the ACH Network and/or Federal Reserve Wire System. SELLER agrees to grant such flexibility. Therefore, SELLER hereby (1) authorizes ISGN to make payments for goods and/or services by EFT, (2) certifies that it has selected the following depository financial institution, and (3) directs that all such electronic funds transfers be made as provided below: VENDOR NUMBER: BANK NAME: BANK ADDRESS: ROUTING NUMBER: ACCOUNT TYPE: (CHECKING/SAVINGS) VENDOR SSN/FEIN: SELLER acknowledges and agrees that the terms and conditions of all agreements or purchase orders with ISGN concerning the methods and timing of payments for goods and/or services shall be amended as provided herein. Value dates on any EFT payments replacing check payments will be extended three (3) days beyond the date required for check payments. SELLER will notify ISGN of any changes in depository financial institution or other payments instructions 15 days in advance. When properly executed, the Authorization will become effective fifteen (15) days after its receipt by ISGN. NAME OF COMPANY: BY: Date (Authorized signature) Note: Please complete, sign and return with vendor packet and a voided check.

9 Criminal Background Check Verification Instructions ISGN requires all its vendors to complete a Criminal Background Check (CBC) before on-boarding. We have partnered with Sterling to obtain CBCs for our vendors at a reduced rate. How Do I Get a CBC? Each contractor must set up an online account through the contractor website using the below link: o The first time you visit the webpage, you will enter the partner code: - FISE9653 o Skip the login and password fields. Click on I am a New User

10 Instruction to Set Up an Account with Sterling: Complete the required business information. When asked for a Company ID, please enter the name of your company. Select the method you wish to have the background check delivered to you (*Select one only E Mail/ Fax). Choose a login and password. This will enable you to access the website after your initial registration to submit additional background check requests if needed. Review and accept the Liability Agreement and Adverse Action Instructions. Under federal Law (Fair Credit Reporting Act), it is required that employers provide information to their employees before a Background Check/Consumer Reports is requested. In addition, the law requires that a written authorization and consent be obtained from each individual prior to request for any consumer report ISGN. All rights reserved. Confidential Page 2 of 5

11 Ordering a Background Check After completing the registration process, a screen showing order background report will appear. You will need to select as below. The next screen will ask for information on the individual you are requesting the background check be processed ISGN. All rights reserved. Confidential Page 3 of 5

12 Payment for Background Checks Payment via major credit cards is required at the time of background request. (*Additional charges may be incurred by the contractor for certain state/government requirements. Please refer to page one for details on website). After the background check is ordered, a billing and payment information screen will appear. You must complete the required fields and proceed. Background Check Reports Average TAT for CBC is 2 3 business days Under Federal Law, any individual who fails the background check must be provided with a copy of the report, along with Summary of Rights under FCRA (Fair Credit Reporting Act) and a toll free number with address. The individual may decide to question or dispute the information on the report ISGN. All rights reserved. Confidential Page 4 of 5

13 Contact Information In case of any issues with the website, please contact Sterling directly at the details below: Phone (Toll-Free) Fax (Toll-Free) Sales Thank you for your continued compliance with these requirements. In case of questions regarding the above, please contact: Vendor Management Toll Free: Option 6 Valuation Vendor Management Fax: Vendor Management isgnvm@isgn.com Website: Address: 2330 Commerce Park Drive NE, Suite 2 Palm Bay, FL ISGN. All rights reserved. Confidential Page 5 of 5

By signing this Signature Page, the Offeror represents and certifies compliance with the attached Certifications and Representations.

By signing this Signature Page, the Offeror represents and certifies compliance with the attached Certifications and Representations. By signing this Signature Page, the Offeror represents and certifies compliance with the attached Certifications and Representations. The full text of a solicitation provision may be accessed electronically

More information

APPENDIX G REPRESENTATIONS & CERTIFICATIONS

APPENDIX G REPRESENTATIONS & CERTIFICATIONS APPENDIX G REPRESENTATIONS & CERTIFICATIONS ORGANIZATION: ADDRESS PHONE: MOBILE: EMAIL: WEB ADDRESS: The Offeror represents and certifies, by completing this form, that the following information is current,

More information

Revised Southern California Edison Company Page 1

Revised Southern California Edison Company Page 1 Diverse Business Enterprise (DBE) Subcontracting Commitment and Reporting Requirements I. Overview It is Edison s goal to provide diverse business enterprises ( DBEs ), such as women, minority and service-disabled

More information

ANTI-DISCRIMINATION POLICY of the SCHOOL DISTRICT OF PHILADELPHIA ADOPTED NOVEMBER 14, 2007

ANTI-DISCRIMINATION POLICY of the SCHOOL DISTRICT OF PHILADELPHIA ADOPTED NOVEMBER 14, 2007 ANTI-DISCRIMINATION POLICY of the SCHOOL DISTRICT OF PHILADELPHIA ADOPTED NOVEMBER 14, 2007 SECTION 1. THE POLICY It is the policy of the School District of Philadelphia (the "District") acting through

More information

APPLICATION FOR STATE CERTIFICATION

APPLICATION FOR STATE CERTIFICATION APPLICATION FOR STATE CERTIFICATION Thank you for your interest in applying for state certification. We ask that you carefully complete each question. If a question is not applicable, simply answer that

More information

APPENDIX A. Definition of Terms

APPENDIX A. Definition of Terms APPENDIX A. Definition of Terms Appendix A provides explanations and definitions useful to understanding the 2015 Public Works Disparity Study. The following definitions are only relevant in the context

More information

**** End Addendum ****

**** End Addendum **** Addendum No. 1, 16-00198-ARLW February 10, 2017 To All Offerers: RFP 16-00198-ARLW FMLA Administration (3 rd Party) of 9,300 Employees, 5-Year Period Addendum No. 1 The following constitutes Addendum No.

More information

Personal Information: *Please complete all information. Use ink and print clearly, so we can get to know you! Last Name:

Personal Information: *Please complete all information. Use ink and print clearly, so we can get to know you! Last Name: In order to be hired, you must be willing to submit to a physical and urinalysis screening. Application is valid for thirty (30) days from Date Received Today s Date: Bausch-American Towers Attn: HR Manager,

More information

CITY OF CALISTOGA DOWN PAYMENT ASSISTANCE PROGRAM LOAN APPLICATION

CITY OF CALISTOGA DOWN PAYMENT ASSISTANCE PROGRAM LOAN APPLICATION DOWN PAYMENT ASSISTANCE PROGRAM LOAN APPLICATION Date Applicant s Name Phone Residence Address Home City, State, Zip Code Phone Mailing Address (If different) FAMILY INFORMATION Applicant or Co-Applicant

More information

Exact title of the position for which you are applying. Applications will only be processed for current vacancy. (Last) (First) (Middle)

Exact title of the position for which you are applying. Applications will only be processed for current vacancy. (Last) (First) (Middle) EFFINGHAM COUNTY BOARD OF COMMISSIONERS Employment Application 601 North Laurel Street Springfield, Georgia 31329 hr@effinghamcounty.org Telephone: 912-754-2104 Fax: 912-754-8402 We are an equal opportunity/drug

More information

SPECIAL PROVISION. Disadvantaged Business Enterprise/Historically Underutilized. in State Funded Construction

SPECIAL PROVISION. Disadvantaged Business Enterprise/Historically Underutilized. in State Funded Construction 1993 Specifications SPECIAL PROVISION Disadvantaged Business Enterprise/Historically Underutilized Business in State Funded Construction The purpose of this Special Provision is to carry out the Texas

More information

Application for Employment

Application for Employment Position Sought: Community Transit of Delaware County, Inc. 206 Eddystone Avenue Suite 200 Eddystone, PA 19022-1594 Application for Employment Date: (Last) (First) (Middle Name) (Street Address) (City)

More information

Last Name First Name Middle Initial ADDRESS Street City County State Zip

Last Name First Name Middle Initial ADDRESS Street City County State Zip APPLICATION FOR EMPLOYMENT Kolberg-Pioneer, Inc. An Equal Opportunity Employer (HRF-002-03 01/16) This application is valid for the calendar year of 2018. Kolberg-Pioneer, Inc. will provide the Social

More information

Voluntary Information for Equal Employment Opportunity Purposes

Voluntary Information for Equal Employment Opportunity Purposes Voluntary Information for Equal Employment Opportunity Purposes Below is a Voluntary Information Sheet that we would like you to complete. It will be used for Equal Opportunity purposes only. The requested

More information

SPECIAL PROVISION. Disadvantaged Business Enterprise in State Funded Construction

SPECIAL PROVISION. Disadvantaged Business Enterprise in State Funded Construction 1993 Specifications SPECIAL PROVISION Disadvantaged Business Enterprise in State Funded Construction The purpose of this Special Provision is to carry out the Texas Department of Transportation's policy

More information

A. FORM W-9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER (TIN) AND CERTIFICATION (Please type or print) Legal Name of Entity (must match TIN)

A. FORM W-9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER (TIN) AND CERTIFICATION (Please type or print) Legal Name of Entity (must match TIN) VENDOR STATEMENT OF BUSINESS AND LEGAL RELATIONSHIPS The Railroad is required by IRS guidelines to obtain a Form W-9 from all payees. This substitute form is designed to fulfill the Form W-9 information

More information

DRAPER LABORATORY SUPPLIER CERTIFICATION

DRAPER LABORATORY SUPPLIER CERTIFICATION DRAPER LABORATORY SUPPLIER CERTIFICATION In accordance with Government regulations and prime contract requirements, Draper must verify certain information about its suppliers. Please complete this form

More information

Volunteer Driver Application

Volunteer Driver Application Volunteer Driver Application PLEASE PRINT This application will be used to establish your eligibility as a volunteer driver for the Drive to Help program. The information you provide helps us assure you,

More information

Offeror Representations and Certifications Commercial Items. Offeror Representations and Certifications Commercial Items (Oct 2010)

Offeror Representations and Certifications Commercial Items. Offeror Representations and Certifications Commercial Items (Oct 2010) NOTE: The following Representations and Certifications document is required for Purchase Orders not exceeding $150K if the contractor is not registered in the Government-wide Online Representations and

More information

SIGNATURE REQUIRED LEGAL NAME OF ENTITY/INDIVIDUAL FILED WITH IRS FOR THIS TAX ID NO.

SIGNATURE REQUIRED LEGAL NAME OF ENTITY/INDIVIDUAL FILED WITH IRS FOR THIS TAX ID NO. BID REQUEST NO.: 19-6006-LL-C STRATEGIC SOURCING SPECIALIST: Leyanna Long TITLE: Audio Visual Equipment and Supplies PHONE NO.: (573) 884-3228 ISSUE DATE: October 23, 2018 E-MAIL: Longlk@umsystem.edu RETURN

More information

SPECIAL PROVISION Disadvantaged Business Enterprise in Federal-Aid Construction

SPECIAL PROVISION Disadvantaged Business Enterprise in Federal-Aid Construction 1995 Metric SPECIAL PROVISION 000---007 Disadvantaged Business Enterprise in Federal-Aid Construction The purpose of this Special Provision is to carry out the U. S. Department of Transportation's (DOT)

More information

ALABAMA DEVELOPMENT OFFICE ADMINISTRATIVE CODE CHAPTER CERTIFIED CAPITAL COMPANIES TABLE OF CONTENTS

ALABAMA DEVELOPMENT OFFICE ADMINISTRATIVE CODE CHAPTER CERTIFIED CAPITAL COMPANIES TABLE OF CONTENTS ALABAMA DEVELOPMENT OFFICE ADMINISTRATIVE CODE CHAPTER 281-2-1 CERTIFIED CAPITAL COMPANIES TABLE OF CONTENTS 281-2-1-.01 Definitions 281-2-1-.02 Certified Capital Company 281-2-1-.03 Qualified Technology

More information

OFFEROR NAME: PART 1 - OFFEROR REPRESENTATIONS AND CERTIFICATIONS

OFFEROR NAME: PART 1 - OFFEROR REPRESENTATIONS AND CERTIFICATIONS 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (FEB 2012) (a) (1) The North American Industry Classification System (NAICS) code for this acquisition is [insert NAICS code]. NAICS Code Search: http://www.census.gov/eos/www/naics/

More information

SUBCONTRACTOR/VENDOR PREQUALIFICATION FORM

SUBCONTRACTOR/VENDOR PREQUALIFICATION FORM SUBCONTRACTOR/VENDOR PREQUALIFICATION FORM In order to develop a more complete knowledge of your company and coordinate with CJW s future opportunities, please complete this form and return to: CJW Construction,

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT Morgan-Keller is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin, age, sex, gender, disability or any other characteristic

More information

California State University Channel Islands Ironwood Hall One University Drive Camarillo, CA (805)

California State University Channel Islands Ironwood Hall One University Drive Camarillo, CA (805) Division of Business and Financial Affairs Procurement & Logistical Services Service Provider/Contractor/: Thank you for your interest in doing business with California State University Channel Islands

More information

ANNUAL REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF OFFERORS FOR PROCUREMENTS EXPECTED TO EXCEED $25,000

ANNUAL REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF OFFERORS FOR PROCUREMENTS EXPECTED TO EXCEED $25,000 ANNUAL REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF OFFERORS FOR PROCUREMENTS EXPECTED TO EXCEED $25,000 Usage: For procurements Expected to Exceed $25,000 Certain representations and certifications

More information

Procedures for Administration of The Mellon Foundation Loan Repayment Program

Procedures for Administration of The Mellon Foundation Loan Repayment Program Procedures for Administration of The Mellon Foundation Loan Repayment Program A. Before graduation, Mellon Fellows should: 1. Discuss all Mellon loan repayment/deferment procedures with the coordinator.

More information

Name Last First M.I. Head of Household

Name Last First M.I. Head of Household PROGRAM APPLICATION Name First Last M.I. Street Address Apt. # City State Zip Phone Cell Email: Household Composition Name Last First M.I. Relationship Head of Household of Birth Age Social Security #

More information

Professional Services Prequalification Questionnaire

Professional Services Prequalification Questionnaire Professional Services Prequalification Questionnaire Note: It is imperative that this questionnaire be completed in its entirety to be considered for review. DE 963-5139 06-11 1. GENERAL Company Name Duns

More information

REPRESENTATIONS AND CERTIFICATIONS Long Form

REPRESENTATIONS AND CERTIFICATIONS Long Form REPRESENTATIONS AND CERTIFICATIONS Long Form The Federal Acquisition Regulations (FAR) require that certain representation/certifications be obtained prior to the award of subcontracts or purchase orders

More information

Employment Application

Employment Application Employment Application To Applicant Instructions We appreciate your interest in our company and we are interested in reviewing your qualifications for our current open positions. To make this the best

More information

ANNUAL REPRESENTATIONS AND CERTIFICATIONS SUBMITTED TO MWH AMERICAS / CONSTRUCTORS, INC.

ANNUAL REPRESENTATIONS AND CERTIFICATIONS SUBMITTED TO MWH AMERICAS / CONSTRUCTORS, INC. ANNUAL REPRESENTATIONS AND CERTIFICATIONS SUBMITTED TO MWH AMERICAS / CONSTRUCTORS, INC. The company / individual below represents and certifies the following information is current, accurate, and complete

More information

HOUSING AUTHORITY OF THE CITY OF MILWAUKEE (HACM)

HOUSING AUTHORITY OF THE CITY OF MILWAUKEE (HACM) HOUSING AUTHORITY OF THE CITY OF MILWAUKEE (HACM) PRIME CONTRACTOR FORMAL CONTRACT PROVISIONS FOR SUBCONTRACTING WITH EMERGING BUSINESS ENTERPRISES* FEDERAL DOLLARS NON-FEDERAL DOLLARS Where Federal dollars

More information

PHILADELPHIA REGIONAL PORT AUTHORITY (PHILAPORT)

PHILADELPHIA REGIONAL PORT AUTHORITY (PHILAPORT) July 15, 2017 Version PHILADELPHIA REGIONAL PORT AUTHORITY (PHILAPORT) Diversity Inclusion Plan (Construction) DIVERSITY AND INCLUSION POLICY MINIMUM PARTICIPATION LEVELS PHILAPORT has established the

More information

NOTICE TO POTENTIAL QUOTERS: - Use of Ozone Depleting Substances

NOTICE TO POTENTIAL QUOTERS: - Use of Ozone Depleting Substances Page 3 of 16 Last update March 2015 NOTICE TO POTENTIAL QUOTERS: - Use of Ozone Depleting Substances In accordance with Section 326 of Public Law 102-484, the Department of Defense is prohibited from awarding

More information

Loan Information and Application Guide

Loan Information and Application Guide INTERNATIONAL OS-HELP ASSISTANCE APPLICATION STUDENT CENTRAL LOCKED BAG 1797, PENRITH NSW 2751 Loan Information and Application Guide The Australian Government provides loans to assist eligible students

More information

Preliminary Rental Application

Preliminary Rental Application OP 241 For Office Use Only Rec d Time Rec d Initials Preliminary Rental Application Please note that this is a preliminary application and gives no lease or rent rights. Community Office ( ) Unit Size

More information

OFFEROR NAME CAGE CODE

OFFEROR NAME CAGE CODE OFFEROR NAME CAGE CODE 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (MAY 2014) ALTERNATE I (MAY 2014) An offeror shall complete only paragraph (b) of this provision if the offeror

More information

Nutrition Services Division DCH 06 (REV. 8/2018) PAGE 1 of 6 MEAL BENEFIT FORM FOR PROVIDERS

Nutrition Services Division DCH 06 (REV. 8/2018) PAGE 1 of 6 MEAL BENEFIT FORM FOR PROVIDERS PAGE 1 of 6 MEAL BENEFIT FORM FOR PROVIDERS Complete, sign, and return this form to your day care home (DCH) sponsor. If you need assistance completing this form, call: (213) 380-3850 Name of DCH provider:

More information

Dear Signing Vendor: Sincerely, Cathy Manges VP, Title Operations

Dear Signing Vendor: Sincerely, Cathy Manges VP, Title Operations Dear Signing Vendor: Thank you for your interest in becoming an approved signing vendor for Mortgage Connect. We are always in search of qualified and knowledgeable professionals who are able to provide

More information

102.1 All applications for certification must meet the following requirements in order to be accepted for City review:

102.1 All applications for certification must meet the following requirements in order to be accepted for City review: 100 CERTIFICATION RULES 100.1 The City of Orlando s MBE and Blueprint Division staff will ensure that companies applying for certification are in compliance with the definitions for minority and women-owned

More information

CATHOLICS FOR HOUSING, INC. (CFH) CFH NOVA DPA APPLICATION CHECK LIST JANUARY 2017

CATHOLICS FOR HOUSING, INC. (CFH) CFH NOVA DPA APPLICATION CHECK LIST JANUARY 2017 CFH NOVA DPA APPLICATION CHECK LIST JANUARY 2017 Application Package Application completed and signed Authorization to Release Information First Time Homebuyer Affidavit Employment / Income Verification

More information

REQUEST FOR QUALIFICATIONS (RFQ) DESIGN OF A MONUMENT SIGN TO INCUDE A FULL ELECTRONIC MESSAGE CENTER SCREEN AT PORT SAN ANTONIO

REQUEST FOR QUALIFICATIONS (RFQ) DESIGN OF A MONUMENT SIGN TO INCUDE A FULL ELECTRONIC MESSAGE CENTER SCREEN AT PORT SAN ANTONIO REQUEST FOR QUALIFICATIONS () DESIGN OF A MONUMENT SIGN TO INCUDE A FULL ELECTRONIC MESSAGE CENTER SCREEN AT PORT SAN ANTONIO I. INTRODUCTION AND PURPOSE This is issued by the Port Authority of San Antonio

More information

To determine your eligibility for the program, the following documentation must be completed and submitted:

To determine your eligibility for the program, the following documentation must be completed and submitted: Dear Applicant, As a participating jurisdiction in the St. Charles Urban County, the City of St. Peters will administer a St. Peters Urban County Home Improvement Loan Program (H.I.L.P) once federal funding

More information

Pacific Ship Repair & Fabrication, Inc. Supplier Annual Representations and Certifications

Pacific Ship Repair & Fabrication, Inc. Supplier Annual Representations and Certifications Supplier/Subcontractor (Offeror/Supplier) shall complete all sections of this Certification and initial/sign as indicated. Failure to furnish the following certifications may be cause for rejection of

More information

Texas Building and Procurement Commission

Texas Building and Procurement Commission Executive Director Randall H. Riley Texas Building and Procurement Commission CHAIRMAN Tom Beard COMMISSIONERS Stuart S. Coleman Noe Fernandez Bob Jones Mary Ann Newman Richard (Rick) Salwen RE: State

More information

Attachment 15 Specified Requirements

Attachment 15 Specified Requirements Attachment 15 Specified Requirements Attachment 15 PART A SPECIFIED REQUIREMENTS The shall comply with, and the Concessionaire shall perform its obligations and (where relevant) shall require each Project

More information

FEDERAL TRANSIT ADMINISTRATION (FTA) CONTRACT CLAUSES. MATERIALS and SUPPLIES. Revised: May, 2017 Materials and Supplies

FEDERAL TRANSIT ADMINISTRATION (FTA) CONTRACT CLAUSES. MATERIALS and SUPPLIES. Revised: May, 2017 Materials and Supplies FEDERAL TRANSIT ADMINISTRATION (FTA) CONTRACT CLAUSES MATERIALS and SUPPLIES Revised: May, 2017 Materials and Supplies FEDERAL TRANSIT ADMINISTRATION CONTRACT CLAUSES INDEX 1. Fly America Requirements

More information

AN EQUAL OPPORTUNITY EMPLOYER DATE SOCIAL SECURITY NUMBER CITY CITY IN CASE OF EMERGENCY NOTIFY: NAME RELATIONSHIP TELEPHONE NUMBER ( ) YES NO

AN EQUAL OPPORTUNITY EMPLOYER DATE SOCIAL SECURITY NUMBER CITY CITY IN CASE OF EMERGENCY NOTIFY: NAME RELATIONSHIP TELEPHONE NUMBER ( ) YES NO Please fill out the application in its entirety FIRST MIDDLE LAST AN EQUAL OPPORTUNITY EMPLOYER DATE SOCIAL SECURITY NUMBER 20 PRESENT STREET CITY STATE ZIP PERSONAL PERMANENT TELEPHONE NUMBER HOME STREET

More information

Small Business Enterprise Program

Small Business Enterprise Program Small Business Enterprise Program Registration & Roster Enrollment Registration Does NOT Pre-Approve You (The City may use this information to develop bid lists, contract lists and reports. Prime contractors

More information

Texas Department of Transportation Page 1 of 46 Contract and Grant Management SUBCHAPTER J. DISADVANTAGED BUSINESS ENTERPRISE (DBE) PROGRAM

Texas Department of Transportation Page 1 of 46 Contract and Grant Management SUBCHAPTER J. DISADVANTAGED BUSINESS ENTERPRISE (DBE) PROGRAM Texas Department of Transportation Page of 0 SUBCHAPTER J. DISADVANTAGED BUSINESS ENTERPRISE (DBE) PROGRAM.00. Purpose of Subchapter; Applicability of Program. (a) This subchapter establishes policies

More information

Hardee County Board of County Commissioners Equal Employment Opportunity (EEO) Self-Identification Form (completion of this form is voluntary)

Hardee County Board of County Commissioners Equal Employment Opportunity (EEO) Self-Identification Form (completion of this form is voluntary) Please submit to: Hardee County Board of County Commissioners HR Department 205 Hanchey Road, Wauchula, Florida 33873 Phone: (863) 773-2161 Hardee County Board of County Commissioners Equal Employment

More information

ESKATON HAZEL SHIRLEY MANOR San Pablo Avenue, El Cerrito, CA PH: (510) FAX: (510) TDD: (800)

ESKATON HAZEL SHIRLEY MANOR San Pablo Avenue, El Cerrito, CA PH: (510) FAX: (510) TDD: (800) RCVD BY DATE TIME ESKATON HAZEL SHIRLEY MANOR 11025 San Pablo Avenue, El Cerrito, CA 94530 PH: (510) 232-3430 FAX: (510) 232-1056 TDD: (800) 735-2922 www.eskaton.org APPLICATION FOR HOUSING PLEASE PRINT

More information

Contractor/Vendor Application Packet. Checklist

Contractor/Vendor Application Packet. Checklist CHOPTANK ELECTRIC COOPERATIVE BOX 430 DENTON, MARYLAND 21629 TEL. 1-877-892-0001 TOLL FREE OWNED BY THOSE WE SERVE Contractor/Vendor Application Packet This Contractor/Vendor Application Packet includes

More information

MEAL BENEFIT FORM FOR PROVIDERS

MEAL BENEFIT FORM FOR PROVIDERS PAGE 1 of 5 MEAL BENEFIT FORM FOR PROVIDERS Complete, sign, and return this form to your day care home (DCH) sponsor. If you need assistance completing this form, call: Juanita Royal (916) 344-6259 Ext.

More information

YOU MUST MEET THE FOLLOWING BASIC REQUIREMENTS TO BE CONSIDERED FOR SELECTION:

YOU MUST MEET THE FOLLOWING BASIC REQUIREMENTS TO BE CONSIDERED FOR SELECTION: YOU MUST MEET THE FOLLOWING BASIC REQUIREMENTS TO BE CONSIDERED FOR SELECTION: You must have attended a Homeowner Information Meeting within the past 6 months. You must have lived or worked in Lee or Hendry

More information

REPRESENTATIONS, CERTIFICATIONS, & STATEMENTS OF BIDDERS/OFFERORS

REPRESENTATIONS, CERTIFICATIONS, & STATEMENTS OF BIDDERS/OFFERORS 1. TYPE OF BUSINESS ORGANIZATION The Bidder/Offeror, by checking the applicable box, represents that (a) It operates as a corporation incorporated under the laws of the State of, an individual, a partnership,

More information

BACKGROUND CLEARANCE INSTRUCTIONS STUDENT APPLICANT

BACKGROUND CLEARANCE INSTRUCTIONS STUDENT APPLICANT BACKGROUND CLEARANCE INSTRUCTIONS STUDENT APPLICANT The amended Child Protective Services Law, effective December 31, 2014, and accompanying policies; PASSHE Board of Governors 2014-01-A (Protection of

More information

MASSACHUSETTS WATER RESOURCES AUTHORITY Employment Application

MASSACHUSETTS WATER RESOURCES AUTHORITY Employment Application MASSACHUSETTS WATER RESOURCES AUTHORITY Employment Application Massachusetts Water Resources Authority is an Equal Opportunity/Affirmative Action Employer. MWRA does not discriminate on the basis of race,

More information

Supplier Profile Form

Supplier Profile Form Supplier Profile Form All new suppliers must be qualified prior to any purchases being made. Please complete the following form and email to purchasingdept@thompsontractor.com or fax to 205-226-6203. Once

More information

Name (First) (Middle) (Last) Address. (City) (State) (Zip Code) (Home Phone Number) (Cell Phone Number) ( Address)

Name (First) (Middle) (Last) Address. (City) (State) (Zip Code) (Home Phone Number) (Cell Phone Number) ( Address) Date Name (First) (Middle) (Last) Address (Number) (Street) (City) (State) (Zip Code) (Home Phone Number) (Cell Phone Number) (Email Address) List previous addresses within last 5 years Are you over 18

More information

City of Shorewood Application for Employment

City of Shorewood Application for Employment City of Shorewood Application for Employment We welcome you as an applicant for employment with the City of Shorewood. It is the City of Shorewood s policy to provide equal opportunity in employment. The

More information

Application for Employment

Application for Employment Application for Employment We welcome you as an applicant for employment with the City of Red Wing. It is the City of Red Wing s policy to provide equal opportunity in employment. The City of Red Wing

More information

State Employees Credit Union Application for Employment

State Employees Credit Union Application for Employment State Employees Credit Union Application for Employment Note: Application must be handwritten. Do not type. We appreciate your interest in our organization. Please complete the application as fully as

More information

APPENDIX B NOTICE OF REQUIREMENTS FOR DISADVANTAGED BUSINESS ENTERPRISE (DBE) March 2012 * * *

APPENDIX B NOTICE OF REQUIREMENTS FOR DISADVANTAGED BUSINESS ENTERPRISE (DBE) March 2012 * * * APPENDIX B NOTICE OF REQUIREMENTS FOR DISADVANTAGED BUSINESS ENTERPRISE (DBE) March 2012 * * * ~Applies only if bid/proposal price is $500,000 or more for a construction contract or $100,000 or more for

More information

Date Position Applied For. Full Name. Last First Middle. Social Security No. Home Phone ( ) Cell Phone ( ) Present Address

Date Position Applied For. Full Name. Last First Middle. Social Security No. Home Phone ( )   Cell Phone ( ) Present Address APPLICATION FOR EMPLOYMENT PLEASE READ CAREFULLY AND ANSWER ALL QUESTIONS. Return completed application to: HR Dept. / 16243 Highway 216 / Brookwood, AL 35444 (Attach a separate sheet if additional space

More information

(Please Print using Black or Blue Ink) SEX: GENDER IDENTITY: MARITAL STATUS: SINGLE MARRIED OTHER

(Please Print using Black or Blue Ink) SEX: GENDER IDENTITY: MARITAL STATUS: SINGLE MARRIED OTHER PATIENT INFORMATION (Please Print using Black or Blue Ink) LAST NAME: FIRST NAME: MIDDLE INITIAL: ADDRESS: CITY: STATE: ZIP: SEX: GENDER IDENTITY: MARITAL STATUS: SINGLE MARRIED OTHER RACE (OPTIONAL):

More information

THE SCHOOL DISTRICT OF PHILADELPHIA OFFICE OF CAPITAL PROGRAMS 44O NORTH BROAD STREET, 3 RD FLOOR PHILADELPHIA, PENNSYLVANIA

THE SCHOOL DISTRICT OF PHILADELPHIA OFFICE OF CAPITAL PROGRAMS 44O NORTH BROAD STREET, 3 RD FLOOR PHILADELPHIA, PENNSYLVANIA THE SCHOOL DISTRICT OF PHILADELPHIA OFFICE OF CAPITAL PROGRAMS 44O NORTH BROAD STREET, 3 RD FLOOR PHILADELPHIA, PENNSYLVANIA 19130-4015 REQUEST FOR PROPOSALS AND QUALIFICATIONS TO PROVIDE PROFESSIONAL

More information

Optum SLCO Provider Biller s Training. Updated June 15, 2017 Optum Salt Lake County

Optum SLCO Provider Biller s Training. Updated June 15, 2017 Optum Salt Lake County Optum SLCO Provider Biller s Training Updated June 15, 2017 Optum Salt Lake County Overview Provider Connect Search Window Enhancement Discharge Form MHER Updates Claim Submissions Emergency indicator

More information

A United Way Member Agency. 7 Hopkins Street, St. Augustine, FL (904) Fax (904)

A United Way Member Agency. 7 Hopkins Street, St. Augustine, FL (904) Fax (904) A United Way Member Agency 7 Hopkins Street, St. Augustine, FL 32084 (904)826-3252 Fax (904)819-1780 www.habitatstjohns.org A United Way Member Agency 7 Hopkins Street, St. Augustine, FL 32084 (904)826-3252

More information

EDUCATION RECORD High School: City/State: Graduate/GED? EMPLOYMENT RECORD EMPLOYER EMPLOYMENT DATES POSITION ELIGIBLE FOR REHIRE Name Start Start

EDUCATION RECORD High School: City/State: Graduate/GED? EMPLOYMENT RECORD EMPLOYER EMPLOYMENT DATES POSITION ELIGIBLE FOR REHIRE Name Start Start Last Name: First Name: Middle Initial: OFFICE USE ONLY: Will Visa or Immigration Status prevent lawful employment? Yes No Phone: Alternate Phone: Today s Date: Date Available: OFFICE USE ONLY: Email: Geographical

More information

IFB No. FQ18119/ST APPENDIX B

IFB No. FQ18119/ST APPENDIX B APPENDIX B 1 NOTICE OF REQUIREMENTS FOR DISADVANTAGED BUSINESS ENTERPRISE (DBE) May 2015 ~Applies only if proposal price is $500,000 or more for a construction contract or $150,000 or more for a supply

More information

Note to all City Departments. Request for Bid (RFB)

Note to all City Departments. Request for Bid (RFB) Note to all City Departments Request for Bid (RFB) This boilerplate should be used on RFB projects. These projects are competitively bid, where the Awarding Authority is looking to award to the lowest

More information

WELCOME TO TORRANCE MEMORIAL PHYSICIAN NETWORK

WELCOME TO TORRANCE MEMORIAL PHYSICIAN NETWORK WELCOME TO TORRANCE MEMORIAL PHYSICIAN NETWORK Thank you for choosing us as your healthcare provider. We have enclosed instructions for filling out the paperwork that will be necessary for your first visit.

More information

REVOLVING LOAN FUND POLICY

REVOLVING LOAN FUND POLICY REVOLVING LOAN FUND POLICY The purpose of this policy is to provide guidance regarding loans from a revolving loan fund (RLF) to private and public entities for projects that benefit the community. Nothing

More information

Employment Application Instructions

Employment Application Instructions Employment Application Instructions General Information IMPORTANT! You must complete all parts of the application. Read the job announcement carefully before you apply. Announcements may contain special

More information

MedStart-5. Application for Assistance

MedStart-5. Application for Assistance MedStart-5 Application for Assistance Transportation Meals Assistance Utilities Co-Payments Adult Home Care Lab Testing For application help, contact us at 1-888-842-2654 To apply for benefits, follow

More information

Money, Finance, and Prices

Money, Finance, and Prices 118 III. Money, Finance, and Prices Snapshot Inflation, as measured by the consumer price index (CPI), exceeded 5.0% in 13 of 47 regional economies in 2017. In 2017, the money supply expanded on an annual

More information

REQUIRED CONTRACT PROVISION FEDERAL AID CONTRACTS UTILIZATION OF DISADVANTAGED BUSINESSES

REQUIRED CONTRACT PROVISION FEDERAL AID CONTRACTS UTILIZATION OF DISADVANTAGED BUSINESSES Sheet 1 of 10 REQUIRED CONTRACT PROVISION FEDERAL AID CONTRACTS UTILIZATION OF DISADVANTAGED BUSINESSES I. INTRODUCTION. The specific requirements for the utilization of Disadvantaged Business Enterprises,

More information

Employee Demographics

Employee Demographics Employee Demographics Employee Name Employee A# Gender Birthdate Date of Hire Social Security Number Mailing Address, City, State, Zip Campus Address (Department and Building/Room) Campus Email Campus

More information

GENERAL INFORMATION (complete for all programs)

GENERAL INFORMATION (complete for all programs) FINANCIAL SELF-RELIANCE DEPARTMENT REQUEST FOR SERVICES I am interested in: Home Ownership Home Buyer s Certificate Foreclosure Prevention/Loss Mitigation Credit Counseling Other: GENERAL INFORMATION (complete

More information

Vendor Information Form

Vendor Information Form NEW YORK STATE HOUSING FINANCE AGENCY HOUSING TRUST FUND CORPORATION NEW YORK STATE AFFORDABLE HOUSING CORPORATION STATE OF NEW YORK MORTGAGE AGENCY STATE OF NEW YORK MUNICIPAL BOND BANK AGENCY TOBACCO

More information

VOLUNTEER APPLICATION

VOLUNTEER APPLICATION VOLUNTEER APPLICATION 405 Canyon Ave Fort Collins, CO 80521 phone: 970-472-9630 fax: 970-472-8393 PERSONAL INFORMATION: 55 & Over Under 55 Name: (LAST) (FIRST) (MI) Address: City: Zip: Home Phone: Cell

More information

1. PLEASE READ CAREFULLY Applications will be processed in order of date and time received.

1. PLEASE READ CAREFULLY Applications will be processed in order of date and time received. Dear Applicant: Thank you for applying for tenancy at W a t e r s E d g e C r e s c e n t 1 located in Elizabeth, New Jersey 07206. Please complete this application in accordance with the following application

More information

Employee Demographics

Employee Demographics Employee Demographics Employee Name Employee A# Gender Birthdate Date of Hire Social Security Number Mailing Address, City, State, Zip Campus Address (Department and Building/Room) Campus Email Campus

More information

Application for Employment

Application for Employment Application for Employment 221 E. Clark St. Albert Lea, MN 56007 We welcome you as an applicant for employment with the City of Albert Lea. It is the City s policy to provide equal opportunity in employment.

More information

NAME (FIRST) (MIDDLE) (LAST) SOCIAL SECURITY NO. (OPTIONAL) DATE OF APPLICATION

NAME (FIRST) (MIDDLE) (LAST) SOCIAL SECURITY NO. (OPTIONAL) DATE OF APPLICATION Bristol Bay Area Health Corporation P.O. Box 130 Dillingham, Alaska 99576 Phone: 1-907-842-5201 --- In Alaska: 1-800-478-5201 Fax: 1-907-842-9251 --- Email: recruitment@bbahc.org BBAHC enforces a drug

More information

Affordable/Income Restricted Housing Lottery Application

Affordable/Income Restricted Housing Lottery Application Affordable/Income Restricted Housing Lottery Application Development Name: Weinberg House Development Address: 132 Chestnut Hill Ave, Brighton MA 02135 Deadline to Submit Application: September 7, 2018

More information

Mobiloil Federal Credit Union Employment Application

Mobiloil Federal Credit Union Employment Application Mobiloil Federal Credit Union Employment Application It is our policy to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age,

More information

GREATER DAYTON REGIONAL TRANSIT AUTHORITY REQUEST FOR PROPOSAL FOR FOOD AND BEVERAGE VENDING SERVICES CONTRACT PROPOSAL NO.

GREATER DAYTON REGIONAL TRANSIT AUTHORITY REQUEST FOR PROPOSAL FOR FOOD AND BEVERAGE VENDING SERVICES CONTRACT PROPOSAL NO. GREATER DAYTON REGIONAL TRANSIT AUTHORITY REQUEST FOR PROPOSAL FOR FOOD AND BEVERAGE VENDING SERVICES CONTRACT PROPOSAL NO. GD 16-25 PREPARED BY GREATER DAYTON REGIONAL TRANSIT AUTHORITY DECEMBER 30, 2016

More information

A Summary of Your Rights Under the Fair Credit Reporting Act

A Summary of Your Rights Under the Fair Credit Reporting Act Supplemental Form - Applicant to Keep AmericanChecked Inc. SECTION 4 SUMMARY OF YOUR RIGHTS 1.1 Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection

More information

Credit365.com BUSINESS CREDIT

Credit365.com BUSINESS CREDIT e Credit365.com BUSINESS CREDIT Now you can get prequalified for the working capital or business credit you need to startup and grow regardless of personal credit.** Register for our FREE webcast about

More information

American Financial Solutions Fax: th Street Bremerton, WA 98337

American Financial Solutions Fax: th Street Bremerton, WA 98337 Thank you for contacting us for Housing Counseling. Attached you will find authorization releases you need to complete prior to scheduling your appointment with a housing counselor. Please read the documents

More information

July Dear Provider:

July Dear Provider: , Inc. Our Mission is to encourage and support the success and well-being of children, families and the child care community... July 2018 Dear Provider: To qualify for tier I reimbursement for meals served

More information

Summer U LEAD Program Application

Summer U LEAD Program Application Summer U LEAD Program Application U LEAD is offers a summer job internship program for Ramsey County Suburban youth ages 14 to 24. Youth must complete the summer application and complete work readiness

More information

WATERWHEEL WORKFORCE HOUSING 867 Saw Mill River Road, Village of Ardsley, Westchester County, NY

WATERWHEEL WORKFORCE HOUSING 867 Saw Mill River Road, Village of Ardsley, Westchester County, NY WATERWHEEL WORKFORCE HOUSING 867 Saw Mill River Road, Village of Ardsley, Westchester County, NY EXPRESSION OF INTEREST Mail or Hand Deliver Completed Application to: at 55 South Broadway, Tarrytown, NY

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT PLEASE ANSWER ALL QUESTIONS AND PRINT LEGIBLY. Please complete each section fully and accurately. Please PRINT, except for the signature at the end of this application. To the

More information

Security Deposit Loan Application 405 SW 6th Street Redmond, Oregon *

Security Deposit Loan Application 405 SW 6th Street Redmond, Oregon * Security Deposit Loan Application 405 SW 6th Street Redmond, Oregon 97756 * 541-923-1018 Thank you for your interest in the Families Forward loan program. Loans are available to Housing Choice Voucher

More information

City of Santa Clarita DISADVANTAGED BUSINESS ENTERPRISE (DBE) PROGRAM

City of Santa Clarita DISADVANTAGED BUSINESS ENTERPRISE (DBE) PROGRAM City of Santa Clarita DISADVANTAGED BUSINESS ENTERPRISE (DBE) PROGRAM Submitted to U.S. Department of Transportation Federal Transit Administration San Francisco, California SANTA CLARITATRANSIT DBE PROGRAM

More information