New Hire Packet. Administrative & Instructional Employees

Size: px
Start display at page:

Download "New Hire Packet. Administrative & Instructional Employees"

Transcription

1 New Hire Packet Administrative & Instructional Employees 1769 East Moody Blvd Bunnell, FL Telephone (386) or (386) Fax (386)

2 Flagler County Schools Human Resources Department New Hire Checklist (Regular Employees) Complete the following. There is a notary available in HR to notarize forms. Authorization to Fingerprint Form Form W4 Form I-9 Complete all of Section 1 and sign form. Section II will be completed by district. Identification Provide copy of Driver s License and Social Security Card. Name on social must match driver s license. New Employee Data Form _ FRS Certification Form Deposit Authorization Select Direct Deposit or District Pay Card and complete required information. Loyalty Oath Read documents pertaining to Code of Ethics, Sexual Harassment, Alcohol & Drug Free Workplace, Johns Eastern Company Employee Info Packet, Family & Medical Leave Fact Sheet, FCSD Electronic Systems Use Agreement, and Rapid Pay Card Reference Guide & Fee Schedule. Sign agreement forms listed below acknowledging that you ve received, read, and understand these documents. Certificate of Agreement Worker s Comp Acknowledgment Acceptable Use Agreement Agreement of Understanding re: Performance Pay Pay Selection Form New Teacher Info Sheet (Teachers only) ERO Form (Certified personnel only) Drug Screening Complete Authorization for Drug Screening form. Take completed form to MediQuick to complete drug screening. Transportation employees should not use this form. Contact Transportation Department for instructions regarding drug screening of Transportation employees. Submit official transcripts Required for all Instructional & Admin; required for Support and Professional who hold a degree. Pick up Benefit packet (if applicable) Verification of Years of Experience Instructional submit Verification of Teaching Experience form to previous employers to complete. Forms must be returned within 90 days to receive credit. Support/Professional staff submit valid letter(s) from previous employer(s) for up to 5 years of experience. Letters must be received by HR within thirty (30) days to receive credit. Bring the following with you to Human 1769 E Moody Blvd, Bldg 2, Bunnell, FL. Payment for fingerprinting (i.e., money order or registration id number if you paid by credit card). Completed New Hire Packet paperwork Copy of Driver s License and Social Security Card (we can also make a copy at the HR office) Please make sure you have two valid references on your job application. A valid reference is a previous supervisor (preferably reflecting employment or volunteer work covering the last five years). If you have been self-employed with no other work experience in the last five years, the reference may be completed by a customer or supplier. If you are currently attending high school or college, references may be a professor, teacher, or counselor. If there is limited or no previous work experience, personal references will be accepted as long as they are not family members. Failure to provide two (2) valid references will delay approval for employment. 2/1/ :55 AM

3 Flagler County Schools Human Resources Department Fingerprint Information Name Last First Middle Social Security Number: _-_- US Citizen: Yes No Aliases AKA Date of Birth Month/Day/Year Place of Birth_ Race: Asian Black White Native American Unknown Sex: Male Female Hair Color: Eye Color: _ Height: ft. in. Weight: pounds Missing Digits (fingers): Address: Phone Number: Money Order: Bank # Credit Card Confirmation # _ Date Init _ Fingerprinted by : _ (Initials) 1769 East Moody Blvd Bunnell, FL (386) Fax (386) Rev. 2/27/14

4

5

6

7

8

9 Flagler County Schools Human Resources Department New Employee Data Form Name: School/Dept: _ Job Title: Address: City: _ State: _ Zip: Phone: Sex: M F Birthdate: Race: Hispanic/Latino Amer Indian/Alaskan Native Asian Black or African American Native Hawaiin or Other Pacific Islander White Local Race: Asian/Pacific Black/Non Hisp Hispanic American Indian White/Not Hispanic Marital Status Single Married Divorced Widowed Legally Separated Veteran Does your spouse work for the Flagler County School District? Yes No If so, what is his or her name? Emergency Contact: _ Number: Personal Education & Experience (If applicable) Type of Degree: Associates Bachelors Masters Specialist Doctorate Major: Total Years of Teaching Experience: # of Years Teaching in Florida Public Schools _ # Yrs in Florida Non-Public _ # of Yrs Teaching in Out of State Public Schools # Yrs Out of State Non-Public Schools Do you hold a Florida Teaching Certificate? Yes No Subject Area(s) of Certification Type of Certificate: Professional Temporary Statement of Eligibility Applied 1769 East Moody Drive Bunnell, FL Telephone (386) Fax (386) Updated 08/07/2015

10 Flagler County Schools Human Resources Department New Teacher Info Sheet Certification All certification correspondence should be processed through Kim Hunt, or Cathy Shopovick, in Human Resources. When receiving written correspondence directly from the Department of Education (DOE) or certificate, please send one copy to the Human Resources office and another copy to your Principal. Retain the original. The General Knowledge test(s) needs to be taken and passed in the first year of your temporary certificate. All temporary certificates will be issued for 3 years but cannot be re issued. You must complete all requirements prior to June 30 of the last year of your certificates validity period for issuance of a Professional certificate. It is the employee s responsibility to keep up with all testing and certification requirements. Leave When you need to be absent from school you must fill out a Leave Form. Teachers earn one (1) day per month of employment per year with four (4) days credited upon employment and six (6) more earned in subsequent months. Instructional staff may transfer earned sick leave from another Florida School District to Flagler County. For more information, please contact Dawn Curry at curryd@flaglerschools.com. Personal Leave Forms must be filled out three (3) days in advance and submitted to the school. Sick Leave Forms may be filled out in advance (appointments) or on the day returning from your illness. Be sure to request a substitute if needed. All absences should be reported to SubFinder either by phone ( ) or by WebConnect. Questions or problems regarding SubFinder should also be directed to the sub coordinator ( x2119 or ). There is no limit to the number of sick leave days that can be accumulated. When an employee retires or leaves employment, sick leave is considered as part of the employee s terminal pay (see contract for percentages and regulation). Observations and Evaluations Walk through visits by guests do not constitute an observation. Walk through visits can be done by school administrators at any time. Please see FCEA contract for more detailed explanations. Instructional personnel hired after July 1, 2011 who are new to the profession or new to the district will receive a probationary contract for the first academic year of service. Such teachers are subject under Florida Statute to two (2) performance evaluations within the probationary year. After each assessment, the teacher shall sign and be given a copy of the instrument. Signature does not mean agreement, but rather awareness of the content.

11 New Teacher Info (Continued) Insurance The Board provides, without cost to the employee, long term disability and group term life insurance. See a Benefit Specialist for coverage details. The Board currently contributes a negotiated amount per month toward the cost of medical insurance for a twelve month period. According to the current contract, this can increase on an annual basis of up to 5%. The Board also contributes toward vision and dental insurance. Please contact a Benefit Specialist for more details. Insurance elections must be made online no later than thirty (30) days from the eligibility date. Information can be obtained from Benefits during new hire processing. Re appointment All certificate requirements must be kept current prior to being re appointed. In addition, all required testing for year one must be completed and passed during the first year of employment. Please note that passing the required tests does not mean guaranteed employment. Records All changes of address and phone numbers should be reported to your school and the Human Resources Department in writing. This can be done via or Name/Address Change Notification Form. Forms are available via the District website under Human Resources. Official transcripts are required upon employment and in obtaining advanced degree pay. Human Resources must have a copy of your Social Security Card and Driver s license. The name on the Social Security Card must match the name on the license. No employee will receive pay prior to being fingerprinted, passing a drug screening, and being cleared from the Human Resource Department. All employment is conditional upon the satisfactory completion of the criminal and background check. A likely result of failing to fully disclose or provide complete background information on the application is grounds for immediate termination of employment. It is the responsibility of the individual teacher to provide all information needed to confirm years of experience for pay. Human Resources cannot give credit for experience until these forms are received in the Human Resources Department. If the forms are not received, the teacher will start at Step 0 (zero), but will receive all pay retroactively once experience is confirmed within 90 days of employment. Advanced Degree Pay is a supplement and is granted when an official transcript is received by the Certification Specialist. All employees hired after July 1, 2011 to the Instructional Staff are annual employees. The State of Florida does not offer Professional Service Contract. _ Employee signature Date This document will be maintained in the employee s personnel file. Rev. 3/2014 Page 2 of 2

12 Florida Retirement System (FRS) - Certification Form This form is not an offer of employment or an enrollment form. If hired, a Retirement Choice kit may be mailed to your home with an enrollment form. Name SSN Agency Name Previous or Current FRS Employer PLEASE COMPLETE SECTION I, II, III, OR IV I. I have never been a member of a State of Florida administered retirement plan. STOP HERE SIGNATURE DATE II. I was or currently am a member of the following State of Florida administered retirement plan (also complete Section III or IV) 1 FRS Pension Plan (incl. DROP) FRS Investment Plan State University System Optional Retirement Program (SUSORP) State Community College Optional Retirement Program (SCCORP) Senior Management Service Optional Annuity Program (SMSOAP) Other III. I am not retired from any State of Florida administered retirement plan. I understand that if it is later determined that I was a retiree and was reemployed during the first 6 calendar months after I retired or after my DROP termination date, or at any time during the 7 th through 12 months after I retired or after my DROP termination date, I must repay all unauthorized benefits received (see Section IV for details), or, if in the Investment Plan, terminate my employment. My employer may also be liable for repaying any unauthorized benefits I received. SIGNATURE IV. I am retired from a State of Florida administered retirement plan. My FRS Pension Plan retirement effective date, DROP termination date, or date I received my first distribution from the FRS Investment Plan, SUSORP, SCCORP, SMSOAP, or other plan was _. If I am initially reemployed by an FRS-covered employer on or after July 1, 2010, I will not be permitted to participate in a State of Florida administered retirement plan to earn an additional retirement benefit. I understand that as a Pension Plan retiree: a. If I am employed by an FRS-covered employer in any type of position 2 during the first 6 calendar months after I retired or after my DROP termination date, my retirement and DROP status are voided, all retirement and DROP benefits I received must be repaid, 3 and I must reapply for retirement in order to receive future benefits. b. If I am reemployed by an FRS-covered employer at any time during the 7 th through the 12 th months after I retired or after my DROP termination date, my monthly retirement benefit must be suspended 4 and any unauthorized benefits received must be repaid. 3 My employer may also be liable for repaying any unauthorized benefits I received. I understand that as an Investment Plan, SUSORP, SCCORP, or SMSOAP retiree: a. If I am employed by an FRS-covered employer in any type of position 2 during the first 6 calendar months after I retired, I must repay 3 any benefits received or terminate employment for an additional period to satisfy the 6 calendar month termination requirement. b. If I am reemployed by an FRS-covered employer at any time during the 7 th through the 12 th months after my retirement, I will not be eligible for additional distributions until I terminate employment or complete 12 calendar months of retirement. 4 DATE Retiree Definition You are considered retired if: 1. You have received any benefits under the FRS Pension Plan (including DROP), or 2. You have taken any distribution (including a rollover) from the FRS Investment Plan, or alternative retirement programs offered by state universities (SUSORP), state community colleges (SCCORP), state government for senior managers (SMSOAP), or local governments for senior managers. SIGNATURE DATE 1 If you are not retired and earned FRS service after certain periods in 2002 (depending on your employer), you must rejoin the FRS retirement plan you were enrolled in when you terminated FRS-covered employment. You may have a one-time 2 nd Election to switch FRS retirement plans. Also, alternative retirement programs are available to certain employees. Contact your employer for deadline and other information. 2 Positions include OPS, temporary, seasonal, substitute teachers, part-time, full-time, regularly established, etc. 3 Florida law requires a return of all unauthorized Pension Plan benefit payments or Investment Plan distributions received by a member who has violated the FRS termination or reemployment provisions. Similar provisions apply to unauthorized SUSORP, SCCORP, or other state-administered plan distributions contact that plan s administrator for details. 4 There are no reemployment exemptions/exceptions for Pension Plan members whose effective date of retirement or DROP termination date is on or after July 1, 2010 or Investment Plan, SUSORP, SCCORP, or SMSOAP members who retire on or after July 1, CERT Revised EMPLOYERS: RETAIN THIS FORM IN THE EMPLOYEE S PERSONNEL FILE. DO NOT SEND THIS FORM TO THE FRS, UNLESS REQUESTED.

13 Flagler County Schools Human Resources Department Deposit Authorization I (we) hereby authorize the Flagler County District School Board, herein after called COMPANY, to initiate credit entries and/or correction entries to our: Checking Savings OR District Pay Card account indicated below at the depository, herein called DEPOSITORY, to credit the same such account. Name:_ Social Security #_ Address: City: State: ZIP CODE:_ FOR DISTRICT PAY CARD ONLY Phone: Date of Birth: This authorization is to remain in full force until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY reasonable opportunity to act upon it. Signature:_ Signature:_ Date:_ Date:_ CHECKING / SAVINGS A VOIDED CHECK OR LETTER FROM BANK MUST BE ATTACHED 1769 East Moody Drive Bunnell, FL Telephone (386) Fax (386) Rev

14 Flagler County Schools Human Resources Department LOYALTY OATH STATE OF FLORIDA COUNTY OF FLAGLER I,, being employed by or as an officer of the (Print Name) Flagler County School District and a recipient of public funds as such employee or officer, do hereby solemnly swear or affirm that I will support the Constitution of the United States and the State of Florida. (Signature of Applicant) State of Florida, County of _. Sworn and subscribed before me this day of, 20, by who is personally known to me or who has produced as identification. Signature of Notary Public Typed, Printed or Stamped Notary My Commission Expires Number Notary Public Commission 1769 East Moody Drive Bunnell, FL Telephone (386) Fax (386) Rev. 02/27/14

15 Flagler County Schools Human Resources Department Certificate of Agreement I do hereby certify that I have received and read the following: The Code of Ethics and the Principles of Professional Conduct of the Education Profession in Florida. The Flagler County School Board Alcohol & Drug-Free Workplace Family Medical Leave (FMLA) policy. Sexual Harassment Policy Employee Access _ Printed Employee Name Employee Signature Date 1769 East Moody Drive Bunnell, FL Telephone (386) Fax (386)

16 Flagler County Schools Human Resources Department Worker s Compensation Acknowledgement Form This will acknowledge that I have been provided the Employee Information Packet regarding worker s compensation for the Flagler County School District. This Employee Information contains the following topics: What medical care am I entitled to? How does the process work? How will I benefit from it? What is the medical referral process? What is the procedure for changing a provider? How can I express any concerns regarding my treatment? What if I require emergency care? I understand that if I have any questions or do not understand any part of the enclosed material, I may contact the Risk Management office for assistance. Printed Employee Name Signature of Employee Date Rev 02/27/ East Moody Drive Bunnell, FL Telephone (386) Fax (386)

17 Flagler County Public Schools HUMAN RESOURCES DEPARTMENT 1769 East Moody Blvd, Bldg. 2 Bunnell, FL Telephone (386) or (386) Fax (386) Agreement of Understanding INSTRUCTIONAL NEW HIRE EVALUATIONS & PERFORMANCE PAY PROCEDURES Instructional personnel who are new to the profession or new to the district are subject, under Florida Statute, to two (2) performance evaluations within their first full year of employment. The first evaluation is to be completed within 90 days of employment. New to the District: 2 informal observations -conference if either party requested Post conference if deficiencies are noted 2 formal observations -conference prior to both Summative Evaluation New instructional personnel hired late in a school year, where time allows for only 1 evaluation to be completed before the end of that school year, will not be eligible for Performance Pay based on the current school year. The second evaluation of New Hires (falling within the first full year of employment) is to be completed the Fall of the following school year with a summative evaluation completed at the end of that school year to which the VAM/SPI/IPLP scores are added for a Final DOE Code submission and subject to Performance Pay, Grant eligibility, etc., if applicable. I,, have read and understand Flagler Please Print Full Name County Public Schools Evaluation and Performance Pay procedures. Signature Date An Equal Opportunity Employer

18 *For certified personnel only Please provide the following information so that we can set you up in ERO (Electronic Register Online). ERO allows you to register for workshops and receive points (credits) toward your recertification. We will send your User ID and PIN via . Full Name Address Phone_ DOB SS # School/Position DOE Certificate #_ Certification Area Date issued_expiration

19 Flagler County School Board Faculty & Staff POLICY # 317 SCHOOL DISTRICT OF FLAGLER COUNTY Acceptable Use Signature Page for Faculty/Staff All staff are governed by the Flagler County Acceptable Use Policy and the Technology Guidelines & Internet Access Policy. By accessing the network, staff are agreeing to abide by the guidelines therein. Violations to these policies can result in the termination of Network and Internet access. I have read and understand the Flagler County School computer Technology Acceptable Use Policy and the Technology Guidelines & Internet Access Policy and agree to abide by the guidelines therein. I understand that if I violate the terms and conditions of the Acceptable Use Policy and the Technology Guidelines that my Internet access and Network access can be terminated and all future access denied. I understand that further disciplinary action may be taken in accordance with the policies provided in the Acceptable Use Policy #317. I understand that Internet Access is filtered in accordance with School Board policies. Name (Print): First M.I. Last Name Location: Signature: Date: 6

20 Flagler County Schools Human Resources Department Pay Selection Form Please indicate your preference for paycheck distribution by marking one of the boxes below: ******THIS FORM MUST BE RETURNED TO PERSONNEL BEFORE YOUR FIRST PAY CHECK OR YOU WILL NOT GET PAID 22 Paychecks (22 equal payments paid every two weeks - ** your deduction selection can only be 19) If your contract is 201 days or more, you are NOT eligible to choose this option. 26 Paychecks (26 equal payments paid every two weeks) Receive summer checks Signature of Employee Date Name of Employee (printed) Last 4 digits of SSN Name of School or Department Personal address not related to employer: Chris Wilkins Kim Hunt 1769 East Moody Boulevard - Building 2 Bunnell, FL Telephone (386) Fax (386)

21 Flagler County Public Schools P. O. Box E. Moody Blvd. Bunnell, FL Phone (386) Fax (386) AUTHORIZATION FOR DRUG SCREENING TEST MediQuick l Urgent Care - 6 Office Park Drive, Palm Coast, FL Phone: Fax: MediQuick Urgent Care 140 Pinnacles Drive, Palm Coast, FL Phone: Fax: The cost of the drug screening test is $35.00 and is the responsibility of the applicant/person. Payment is due at the time of the drug screening test and can be paid by, CASH, CHECK, MONEY ORDER or CREDIT CARD Please bring a list of all your prescription drugs with you at the time of testing; this will assist with the results of your test. The following applicant/person has been authorized by Flagler County Schools Human Resource Department to receive a Drug Screening Test, by MediQuick Urgent Care. Date: _ Applicant/Person Name: Social Security: _ Job Title: Department: _ Applicant/Person Signature: This Drug Screening Testing is being performed for the following reason: Pre-Employment Drug Screening Post- Employment Drug Screening Return from Leave of Absence Random

22 BOARD OF EDUCATION Andy Dance Chairman District 1 TO: FROM: P. O. Box E. Moody Blvd. Bldg. 2 Bunnell, FL Phone (386) Fax (386) NEW INSTRUCTIONAL PERSONNEL HUMAN RESOURCES Colleen Conklin Vice Chairman District 3 Sue Dickinson Board Member District 5 Trevor Tucker Board Member District 4 John Fischer Board Member District 2 Student School Board Member Lauren Umpenhour Flagler Palm Coast H.S. Student School Board Member Cassandra Cuyler Matanzas H.S. Teacher of the Year Jill Espinosa Belle Terre Elementary School Employee of the Year Cindy Moore Exceptional Education Janet Valentine Superintendent Jacob Oliva Assistant Superintendent SUBJECT: VERIFICATION OF SATISFACTORY TEACHING EXPERIENCE Previous satisfactory teaching experience must be verified on the attached verification form to be placed at the appropriate salary level. Article XIX (C) of the FCEA contract states: All teachers new to Flagler County Schools shall receive credit on the Flagler County School District s salary schedule for all previous teaching experience in Florida and be placed at the same step on the salary schedule as other Flagler County teachers with the same number of years of experience. Teachers from out of state or from non public schools as long as the experience was at a school accredited by a recognized national or regional accrediting association and the teacher was required to have and did, in fact, hold a state issued professional teaching credential during the period of that non public school experience, will receive their years of experience up to ten years, and be placed at the step on the salary schedule of other teachers with the same years of experience. If the years of experience are in and out of state, the teacher can receive either all of their years of experience in state or their out of state years up to ten years, effective upon ratification of the Florida County Educators Association Contract. This language shall not apply to the class of teachers that the School Board has identified as the critical teacher shortage area, for the school year and thereafter. New employees beginning July 1, 2014 receiving retirement in state or out of state will receive the salary equivalent to that of the beginning step on the grandfathered salary schedule. It is the responsibility of the teacher to provide, on the form furnished by the district, complete verification of all full time, satisfactory teaching experience earned outside of the Flagler County School District. The top portion of each form should be completed by you with your full name and social security number. Please have the school district where you taught complete this form in all areas. You may wish to use the attached request form letter for your previous school district s use. The form should be returned to Flagler County School District, Human Resources Department, 1769 East Moody Blvd, Bunnell, FL At your time of hire you will be placed on the appropriate step of the salary schedule, based on completed verification forms received in the Human Resources Department. You must have all verifications in to the Human Resources Department no later than 90 days from employment. Should you have any questions, please contact your Human Resource Office for assistance Thank you for your cooperation.

23 Flagler County Schools Human Resources Department Verification of Teaching Experience TO: NAME: SSN: FOR: COMPUTING AND VERIFYING TEACHING EXPERIENCE FOR SALARY PURPOSES The above named person has been appointed to a position in this school system. Since additional salary may be paid for creditable years of experience, please complete the columns below as applicable. Do not list substitute teaching experience. PLEASE USE A SEPARATE LINE FOR EACH YEAR AND COMPLETE ALL APPLICABLE COLUMNS. Term of Service FROM TO HRS Per Day (PT Only) # of Days in School Year # of Months in School Year # of Days Worked Per Year Public or Private** Name & Address of School **FOR FLORIDA SCHOOL DISTRICTS** This will certify that held a signed continuing contract or professional service contract in county, Florida. OR This will certify that did not hold a continuing contract or professional services contract in county, Florida. I certify that according to our records First Middle Maiden Last Name Was employed in the schools of in the position of City, as stated herein. ** If private school experience is being requested was the school accredited? YES NO Dates of accreditation Accrediting Agency: Was this teacher required to have a State Teaching Certificate for the position experience was gained in? YES NO Signature of School Official Typed/Printed Name & Title Date Phone Number 1769 East Moody Drive Bunnell, FL Telephone (386) Fax (386)

24 Employee Access Instructions Overview Employee Access is an area in the district s HR system (Skyward) that allows an employee to review areas such as payroll, tax, and time off information. Effective April 1, 2014, the Flagler County School District will no longer print check stubs. Employees can use Employee Access in Skyward to view their pay stubs Setting Up A Password A login id and password is required for Employee Access. In order to set up a password for Employee Access, an active district issued address is required. If you do not have or know your district address, please contact the Technology staff member assigned to your school or center. 1) Go to and scroll down to the bottom of the Home page. Click on Employee Access. 2) Click on Forgot your Login/Password. 3) Enter the two (2) scrambled words in the box and your district issued address next to or User Name. Click Submit.

25 Employee Access (Continued) 4) Your user name (firstname.lastname) and login information will be ed to your school web mail account. Please follow ed instructions and make sure the pop-blocker has been turned off. Example of the system will send From: To: YOU Subject: Skyward Account Information Importance: High Dear Your Name, You have been given the ability to access Skyward Business. Click on the following link to obtain a password in order to access this system. Your Login: FirstName.LastName 5) Upon following the link, a screen will appear prompting employee to create a Skyward Business/Employee Access password. Passwords must have 6-8 characters. It is recommended that you include at least one upper case letter and one number or symbol. Passwords are valid for 60 days.

26 Employee Access (Continued) Viewing Your Pay Stub 1) Pay stub information can be seen by clicking on the Employee Info tab. Two boxes will appear: Employee Information and Payroll. Under the Payroll box, click on Check History. To view a particular check stub, highlight the check date you want to see and click on Show Check located on the right hand side. Viewing Salary Information (does not apply to as needed subs) 1) From the Employee Information tab, click on Personal Information then Assignments (located on the left side bar). 2) Verify the Assignment Year is the current school year. 3) Click on the arrow next to the current Position/Assignment. Note: there may be multiple positions if you changed job titles, transferred to another school/department, or had a change in hours or days, etc. 4) Click on arrow next to Salary Information or Payroll Information (to see daily and hourly rate). Viewing Time Off (does not apply to as needed subs) 1) Click on Time Off located in the top left hand corner of the screen. 2) Click on My Status. 3) Screen opens displaying time off codes available to the employee. Each code can be opened (expanded) for more information by clicking on the arrow next to each code (i.e., Sick Leave or Vacation). Exiting Employee Access ALWAYS exit the Skyward program by clicking on EXIT in the upper right hand corner of your screen. Who to Contact for Employee Access Issues 1) If for any reason you still cannot view Employee Access after following the instructions above, please submit a Help Desk ticket through SysAid which will notify your Technology staff member at your school or center. 2) Questions regarding salary should be directed to Human Resources. 3) As Needed/Subs may contact the Technology Department: x2209/x2259

Substitutes, Temporaries, As Needed & Coaches

Substitutes, Temporaries, As Needed & Coaches New Hire Packet Substitutes, Temporaries, As Needed & Coaches 1769 East Moody Blvd Bunnell, FL 32110 Telephone (386) 586-2391 or (386) 437-7526 Fax (386) 586-2396 www.flaglerschools.com We conform to all

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

FRS INVESTMENT PLAN INVESTMENT PLAN EXIT CHECKLIST

FRS INVESTMENT PLAN INVESTMENT PLAN EXIT CHECKLIST FRS INVESTMENT PLAN INVESTMENT PLAN EXIT CHECKLIST Name: Date: EMPLID: Position: School/Dept: PLEASE NOTE: SUBMISSION OF THIS FORM DOES NOT ENROLL YOU IN THE FRS INVESTMENT PLAN. For information on enrolling

More information

City of Becker Employment Application

City of Becker Employment Application Date Received: Received By: City of Becker Employment Application Return to: Becker Community Center PO Box 250 Becker, MN 55308 Ph: 763-200-4271 Fax: 763-261-2018 Applicant Name: Last First Middle Initial

More information

Last Name First Name Middle Name. Street Address City State Zip Code

Last Name First Name Middle Name. Street Address City State Zip Code EMPLOYMENT APPLICATION Clean All Services is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin,

More information

We Do Business in Accordance to the Federal Fair Housing Law

We Do Business in Accordance to the Federal Fair Housing Law PLEASE COMPLETE IN FULL Housing Authority of the City of Fort Myers Affordable Housing - HORIZONS APARTMENTS 5360 Summerlin Road, Fort Myers, FL 33919 Telephone (239) 936-6760 Fax (239) 936-6761 TDD (239)

More information

Post-Doc, Post-Doc Trainee & Instructor

Post-Doc, Post-Doc Trainee & Instructor Post-Doc, Post-Doc Trainee & Instructor NEW-HIRE DOCUMENTS: Emergency Contact Information Form New Employee Disclosure Form Release of Reference Form Request for Verification of Prior State Service Form

More information

Welcome To Tri-County Technical College

Welcome To Tri-County Technical College Tri-County Technical College Personnel Office 7900 Hwy 76, Pendleton, SC 29670 RH Library/Administration Building, Room 103 864-646-1792 Welcome To Tri-County Technical College We are pleased that you

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

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT Prospective people will receive consideration without discrimination because of race, religion, color, sex, age, national origin, handicap, sexual orientation or veteran status.

More information

APPLICATION FOR EMPLOYMENT DISTRICT 19, MEDICAL EXAMINERS OFFICE

APPLICATION FOR EMPLOYMENT DISTRICT 19, MEDICAL EXAMINERS OFFICE APPLICATION FOR EMPLOYMENT DISTRICT 19, MEDICAL EXAMINERS OFFICE www.irsc.edu Indian River State College, Building I 2500 South 35 th Street, Fort Pierce, Florida 34981 Telephone: 1-866-866-4722 This application

More information

ADMINISTRATOR SALARY SCHEDULE. FY18 ( School Year)

ADMINISTRATOR SALARY SCHEDULE. FY18 ( School Year) ADMINISTRATOR SALARY SCHEDULE FY18 (2017-2018 School Year) Board Approved and Adopted: March 27, 2018 Signatures of Superintendent of Schools and School Board Chairman on File Table of Contents PREAMBLE...

More information

AGREEMENT TO PROVIDE APPLIED BEHAVIOR ANALYSIS SERVICES THE SCHOOL BOARD OF SARASOTA COUNTY AND POSITIVE BEHAVIOR INTERVENTIONS, INC.

AGREEMENT TO PROVIDE APPLIED BEHAVIOR ANALYSIS SERVICES THE SCHOOL BOARD OF SARASOTA COUNTY AND POSITIVE BEHAVIOR INTERVENTIONS, INC. AGREEMENT TO PROVIDE APPLIED BEHAVIOR ANALYSIS SERVICES THE SCHOOL BOARD OF SARASOTA COUNTY AND POSITIVE BEHAVIOR INTERVENTIONS, INC. This Contract is entered into June 4, 2013, effective July 1, 2013,

More information

Applications will only be accepted from

Applications will only be accepted from May 2018 Dear Applicant, Thank you for your interest in applying to Pikes Peak Habitat for Humanity! Enclosed you will find the Habitat for Humanity application. Before completing the application, please

More information

1. APPLICANT INFORMATION. Co-Applicant (spouse must be Co-Applicant) Name Male Female Name Male Female

1. APPLICANT INFORMATION. Co-Applicant (spouse must be Co-Applicant) Name Male Female Name Male Female Return by on to: Habitat for Humanity of Greater Plainfield & Middlesex County 2 Randolph Road Plainfield, NJ 07060 Include 25 processing fee in check or money order only. Questions? Call Plainfield Habitat

More information

PRE-HIRE CHECKLIST. PRIOR TO HIRING: These forms must be completed & ed to or faxed to

PRE-HIRE CHECKLIST. PRIOR TO HIRING: These forms must be completed &  ed to or faxed to PRE-HIRE CHECKLIST NAME: (Last, First, Middle) Hire Date: Department: PRIOR TO HIRING: These forms must be completed & emailed to newhires@elmllc.com or faxed to 406.327.6895. Manager Prehire Application

More information

Nebraska Ryan White Program

Nebraska Ryan White Program For office use only: Date Received: MR#: Nebraska Ryan White Program Application Information Date: Check all the programs applying for: Part B Part C Part D ADAP ADAP co-payment assistance Wait list If

More information

ADMINISTRATOR SALARY SCHEDULE FY18. Board Approved

ADMINISTRATOR SALARY SCHEDULE FY18. Board Approved ADMINISTRATOR SALARY SCHEDULE Adopted this 14 th Day of November, 2017 The School Board of Lee County, Florida Signature on File Superintendent of Schools Signature on File School Board Chairman Board

More information

HealthyCare Card Application

HealthyCare Card Application HealthyCare Card Application This is an application for the HealthyCare Card, a program of Healthy Community Network. The HealthyCare Card (HCC) is a community program which provides discounts to care

More information

Application Instructions

Application Instructions Colorado CLT Application Instructions You must submit a completed application with all the required documentation prior to signing a contract for purchase. To ensure your application is complete, please

More information

CONTRACT FOR EDUCATIONAL SERVICES. THE SCHOOL BOARD OF SARASOTA COUNTY, FLORIDA and PINES OF SARASOTA, INC.

CONTRACT FOR EDUCATIONAL SERVICES. THE SCHOOL BOARD OF SARASOTA COUNTY, FLORIDA and PINES OF SARASOTA, INC. June 15, 2010 Item # CONTRACT FOR EDUCATIONAL SERVICES THE SCHOOL BOARD OF SARASOTA COUNTY, FLORIDA and PINES OF SARASOTA, INC. This Contract is entered into June 15, 2010, between THE SCHOOL BOARD OF

More information

We Do Business in Accordance to the Federal Fair Housing Law

We Do Business in Accordance to the Federal Fair Housing Law PLEASE COMPLETE IN FULL SW Florida Affordable Choice Foundation, Inc. Application for Covington Meadows Covington Meadows Circle, Lehigh Acres, FL 33936 Telephone (239) 344-3220 Fax (239) 344-3273 TDD

More information

CITY OF LAUDERHILL POLICE OFFICERS RETIREMENT PLAN DROP APPLICATION PACKAGE

CITY OF LAUDERHILL POLICE OFFICERS RETIREMENT PLAN DROP APPLICATION PACKAGE CITY OF LAUDERHILL POLICE OFFICERS RETIREMENT PLAN DROP APPLICATION PACKAGE DROP APPLICATION PACKAGE City of Lauderhill Police Officer s Retirement Plan Index Pages Application for Deferred Retirement

More information

APPLICATION FOR HOUSING

APPLICATION FOR HOUSING APPLICATION FOR HOUSING All applicants must demonstrate a Need, an Ability to Pay a mortgage and a Willingness to Partner. The following information outlines the Home Ownership Program requirements. If

More information

Mailing Address (Street) (Apt) Telephone Numbers: Work: ( ) - Home: ( ) - (City) (State) (Zip Code) Other: ( ) -

Mailing Address (Street) (Apt) Telephone Numbers: Work: ( ) - Home: ( ) - (City) (State) (Zip Code) Other: ( ) - CITY OF ORANGE CITY HUMAN RESOURCES AN EQUAL OPPORTUNITY EMPLOYER 205 EAST GRAVES AVENUE ORANGE CITY, FL 32763 (386-775-5457) THE CITY OF ORANGE CITY ONLY ACCEPTS APPLICATIONS FOR OPEN POSITIONS Instructions:

More information

APPLICATION FOR RETIREMENT

APPLICATION FOR RETIREMENT RET-54 (1/2001) APPLICATION FOR RETIREMENT New York State Teachers Retirement System 10 Corporate Woods Drive, Albany New York 12211-2395 Social Security Number Write your Social Security number in 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

HOMEOWNERSHIP APPLICATION (Rev. 3/16/17) = Submit a copy of each requested item to the application

HOMEOWNERSHIP APPLICATION (Rev. 3/16/17) = Submit a copy of each requested item to the application PART 1: Applicant(s) Information HOMEOWNERSHIP APPLICATION (Rev. 3/16/17) = Submit a copy of each requested item to the application Application deadline: no exceptions APPLICANT (Head of Household owner

More information

K A T L C KENTUCKY Revised June, 2011

K A T L C KENTUCKY Revised June, 2011 K A T L C KENTUCKY ASSISTIVE TECHNOLOGY LOAN CORPORATION FIFTH THIRD BANK, INC. Providing Financial Loans for Assistive Technology LOAN APPLICATION This Loan Program is Operated Jointly With PLEASE READ

More information

Welcome to Our Practice

Welcome to Our Practice Welcome to Our Practice Greater Baltimore Medical Center (GBMC) welcomes you to our practice. We are dedicated to providing you with the kind of care that we would want for our own loved ones. This Information

More information

THINKING OF RETIRING?

THINKING OF RETIRING? 33 Plaza La Prensa, Santa Fe, New Mexico 87507 (505) 476-9401 fax (505) 476-9300 voice (800) 342-3422 Toll-Free www.nmpera.org PERA INFORMATION SHEET THINKING OF RETIRING? If you are considering retiring,

More information

Jackson Municipal Airport Authority Certified Police Officer

Jackson Municipal Airport Authority Certified Police Officer Jackson Municipal Airport Authority Certified Police Officer This is a certified law enforcement officer position. Successful candidates will perform a variety of duties in the enforcement of laws, rules

More information

HOME SWEET HOME COMMUNITY REDEVELOPMENT CORPORATION

HOME SWEET HOME COMMUNITY REDEVELOPMENT CORPORATION Customer Intake Form CUSTOMER 1 P age HOME SWEET HOME COMMUNITY REDEVELOPMENT CORPORATION Please print Name: Address: City: State: Zip Code: Date of Birth: / / Social Security: - - Gender: Male Female

More information

Employment Application

Employment Application Personal Information Name (Last, First, MI) Date Email Position Applying For? What pay rate are you looking to make? How did you hear about the position? Position Specifications and Work Certifications

More information

May be furnished by any three (3) persons who have known the applicant (agent) for at least three (3) years. Include name, address & phone number.

May be furnished by any three (3) persons who have known the applicant (agent) for at least three (3) years. Include name, address & phone number. Two Original Applications Personal History Form Lease or Valid Document Photographs Corporate Papers Letters of Reference Financial Investments Please write legibly in BLACK ink or type information. Answer

More information

Accident Reporting Packet

Accident Reporting Packet Accident Reporting Packet Employee/ First Name: SSN: Last Name: Position: Date of Hire: When an accident occurs, no matter how minor, please call Corporate Solutions 1-888- 785-4018 immediately and report

More information

INSTRUCTIONS FOR COMPLETING DBPR ABT 6004 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO CHANGE TO LICENSED ENTITY APPLICATION

INSTRUCTIONS FOR COMPLETING DBPR ABT 6004 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO CHANGE TO LICENSED ENTITY APPLICATION INSTRUCTIONS FOR COMPLETING DBPR ABT 6004 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO CHANGE TO LICENSED ENTITY APPLICATION If you have any questions or need assistance in completing this application,

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION EMPLOYMENT APPLICATION POSITION APPLYING FOR: APPLICATION DATE: PERSONAL LAST NAME FIRST NAME MI PRIOR NAME(S), IF APPLICABLE MAILING ADDRESS CITY STATE ZIP WORK PHONE HOME PHONE CELL PHONE EMAIL ADDRESS

More information

STOUTLAND R-II SCHOOL DISTRICT SALARY PROTOCOL

STOUTLAND R-II SCHOOL DISTRICT SALARY PROTOCOL STOUTLAND R-II SCHOOL DISTRICT SALARY PROTOCOL 2017-2018 STOUTLAND R-II SCHOOL DISTRICT SALARY PROTOCOLS 2017-2018 - Certified Staff Salary Protocol - Classified Staff Salary Protocol Approved 7/20/17

More information

Punta Gorda Volunteer Fire Department

Punta Gorda Volunteer Fire Department Note to applicant: Please follow these steps, in order, so your application can be processed in an expedient manner. 1. Complete all applicable form fields beginning on page 3. 2. Print the application

More information

Personal Data Form. UIN#: Dr. Mr. Mrs. Ms. Last Name: First Name: Middle Initial:

Personal Data Form. UIN#: Dr. Mr. Mrs. Ms. Last Name: First Name: Middle Initial: Personal Data Form UIN#: Dr. Mr. Mrs. Ms. Last Name: First Name: Middle Initial: Preferred Name (if different than above): Social Security Number: Mailing Address (same as W4): City: Zip/Postal Code: Permanent

More information

Personal Data Form. UIN#: Dr. Mr. Mrs. Ms. Last Name: First Name: Middle Initial:

Personal Data Form. UIN#: Dr. Mr. Mrs. Ms. Last Name: First Name: Middle Initial: Personal Data Form UIN#: Dr. Mr. Mrs. Ms. Last Name: First Name: Middle Initial: Preferred Name (if different than above): Social Security Number: Mailing Address (same as W4): City: Zip/Postal Code: Permanent

More information

RENTAL APPLICATION CHECKLIST

RENTAL APPLICATION CHECKLIST RENTAL APPLICATION CHECKLIST Please note: The application will not be accepted with incomplete information and missing documentation. All documents requested must be provided. Name: Date & Time: Applicant(s)

More information

ESCORT INFORMATION SHEET

ESCORT INFORMATION SHEET ESCORT INFORMATION SHEET The materials listed below are needed to file all applications except Alcohol Applications. 1. Duplicate Applications Answer all questions appropriately and in detail, legibly,

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

Personal Data Form. UIN#: Dr. Mr. Mrs. Ms. Last Name: First Name: Middle Initial:

Personal Data Form. UIN#: Dr. Mr. Mrs. Ms. Last Name: First Name: Middle Initial: Personal Data Form UIN#: Dr. Mr. Mrs. Ms. Last Name: First Name: Middle Initial: Preferred Name (if different than above): Social Security Number: Mailing Address (same as W4): City: Zip/Postal Code: Permanent

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

AN EQUAL OPPORTUNITY EMPLOYER/AA/ADA AND DRUG FREE

AN EQUAL OPPORTUNITY EMPLOYER/AA/ADA AND DRUG FREE P. O. Box 52488, Tulsa, OK 74152 (918) 582-2100 FAX (918) 599-7266 APPLICATION FOR EMPLOYMENT PLEASE PRINT OR TYPE NAME (FIRST, MIDDLE, LAST SOCIAL SECURITY NO.) PRESENT ADDRESS (STREET, CITY, STATE &

More information

This is an application for PCIP and MRMIP. Tell us which health insurance program you prefer.

This is an application for PCIP and MRMIP. Tell us which health insurance program you prefer. Application Fill out this form to apply for PCIP and MRMIP. Complete all questions on the application, as they must be fully answered. If you do not provide all necessary information, the processing of

More information

Our Mission. Promoting Independence by Providing Car Care

Our Mission. Promoting Independence by Providing Car Care Please Submit the Following: Our Mission Check List Douglas County Residents Only Promoting Independence by Providing Car Care FOR ALL APPLICANTS Fill out application completely and sign Sign the attached

More information

Financial Assistance Guidelines

Financial Assistance Guidelines Financial Assistance Guidelines The Pomona Valley YMCA provides financial assistance to all who want to participate in the YMCA programs based on eligibility and availability of funds. Every application

More information

**ATTN: SOME PAGES NEED TO BE FILLED OUT ON BOTH SIDES**

**ATTN: SOME PAGES NEED TO BE FILLED OUT ON BOTH SIDES** **ATTN: SOME PAGES NEED TO BE FILLED OUT ON BOTH SIDES** APPLICANT FLOW DATA Applicants are considered without regard to race, color, creed, national origin, religion, sex, disability, age, marital status,

More information

Affordable Unit Application Chelmsford Woods Residences Chelmsford, MA

Affordable Unit Application Chelmsford Woods Residences Chelmsford, MA Affordable Unit Application Chelmsford Woods Residences Chelmsford, MA This is an important document. If you need help with language translation, please contact CHOICE Inc. at 978-256-7425 x10 for free

More information

COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME:

COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME: SUBJECT: APPLICANT FOR RESIDENCY TAX CREDIT COMMUNITIES COMMUNITY: PROGRAM: ORIGINAL DATE: TIME: UPDATE: TIME: HOW DID YOU HEAR ABOUT US? APARTMENT SIZE: APPLICANT NAME (FIRST, MIDDLE, LAST): CURRENT ADDRESS:

More information

INSTRUCTIONS FOR COMPLETING DBPR ABT 6004 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO CHANGE OF OFFICER/STOCKHOLDER APPLICATION

INSTRUCTIONS FOR COMPLETING DBPR ABT 6004 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO CHANGE OF OFFICER/STOCKHOLDER APPLICATION INSTRUCTIONS FOR COMPLETING DBPR ABT 6004 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO CHANGE OF OFFICER/STOCKHOLDER APPLICATION Application begins on page 3 If you have any questions or need assistance

More information

Application for Pension

Application for Pension UNITED FOOD AND COMMERCIAL WORKERS UNIONS AND EMPLOYERS MIDWEST PENSION FUND 18861 90 th Ave, Suite A Mokena, IL 60448 800-621-5133 FAX 847-384-0188 www.ufcwmidwest.org Application for Pension First Name

More information

APPLICATION DEADLINE: NOVEMBER 30, 2018

APPLICATION DEADLINE: NOVEMBER 30, 2018 Apply for Fair & Affordable Rental Housing in: 5 Liberty Way, Somers, New York APPLICATION DEADLINE: NOVEMBER 30, 2018 MAIL OR HAND DELIVER APPLICATION TO: at 55 South Broadway, Tarrytown, NY 10591 Phone:

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

FAIRFIELD PUBLIC SCHOOLS. Munis Self Service

FAIRFIELD PUBLIC SCHOOLS. Munis Self Service FAIRFIELD PUBLIC SCHOOLS Munis Self Service Employee Self Service User Guide Version 10.5 https://fairfieldboe.munisselfservice.com/default.aspx LOG IN: Username: first initial, last name, last 4 of your

More information

Dakota County CDA Homebuyer Counseling Program Application

Dakota County CDA Homebuyer Counseling Program Application Dakota County CDA Homebuyer Counseling Program Application Appointment Information: Date: Time: Application Checklist: To better serve you, please provide all required documents 24 hours in advance of

More information

P E N N S Y L V A N I A Application for Payment of Medicare Premiums, Coinsurance and Deductibles

P E N N S Y L V A N I A Application for Payment of Medicare Premiums, Coinsurance and Deductibles P E N N S Y L V A N I A Application for Payment of Medicare Premiums, Coinsurance and Deductibles If you have a disability and need this form in large print or another format, please call our helpline

More information

INDIVIDUAL DEVELOPMENT ACCOUNT (IDA) APPLICATION

INDIVIDUAL DEVELOPMENT ACCOUNT (IDA) APPLICATION INDIVIDUAL DEVELOPMENT ACCOUNT (IDA) APPLICATION Please read each page carefully then complete all pages in this IDA Application Packet, making sure to sign and/or initial where indicated. The completed

More information

MEDICATION ASSISTANCE PROGRAM

MEDICATION ASSISTANCE PROGRAM 1993 Harrison Street Batesville, AR 72501 870.698.9991 (P) 870.698.0022 (F) 1200 South Main Street Searcy, AR 72143 501.268.5000 (P) 501.268.5006 (F) MEDICATION ASSISTANCE PROGRAM Dear Client, Enclosed

More information

3. Mailing address Apt # City State ZIP code

3. Mailing address Apt # City State ZIP code Form 13614-C (October 2018) You will need: Tax Information such as Forms W-2, 1099, 1098, 1095. Social security cards or ITIN letters for all persons on your tax return. Picture ID (such as valid driver's

More information

If you have questions about how much your fee will be, you may stop by or call with your income information before your appointment.

If you have questions about how much your fee will be, you may stop by or call with your income information before your appointment. 238 Arsenal Street, Watertown, NY Family Practice Office: (315) 782-6400 Fax: (315) 782-1330 Adult Office: (315) 782-9903 Fax: (315) 788-0087 Dental Office: (315) 788-9834 Fax: (315) 788-5456 7785 N. State

More information

License Application for Electrical Trades (Instructions for all electrical trades)

License Application for Electrical Trades (Instructions for all electrical trades) License Application for Electrical Trades (Instructions for all electrical trades) 1. WHO MUST FILE FOR EXAMINATION: Any resident or non-resident of Hillsborough County who intends to operate a business

More information

APPLICATION PACKET. Please read pages 1 through 6 for some important things you ll need to know before you apply.

APPLICATION PACKET. Please read pages 1 through 6 for some important things you ll need to know before you apply. DEPARTMENT OF HEALTH AND FAMILY SERVICES Division of Health Care Access and Accountability HCF 10182 (02/08) STATE OF WISCONSIN APPLICATION PACKET Please read pages 1 through 6 for some important things

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

Equity Loan, Line of Credit, and Consumer Loan Application

Equity Loan, Line of Credit, and Consumer Loan Application Equity Loan, Line of Credit, and Consumer Loan Application Thank you for considering Investors Savings Bank for your banking needs. Your completed application may be mailed to Investors Savings Bank, 101

More information

Affordable Homeownership Program Application: Instructions

Affordable Homeownership Program Application: Instructions Affordable Homeownership Program Application: Instructions Habitat reviews applications on a first come, first served basis. Please expect the entire application process to take between 1 3 months. Instructions

More information

Retirement. School District of Palm Beach County. Human Resources. Charting the Course. FRS Pension Plan

Retirement. School District of Palm Beach County. Human Resources. Charting the Course. FRS Pension Plan School District of Palm Beach County Human Resources Retirement Charting the Course FRS Pension Plan Retirement is one of the most important decisions you will ever make. Whether your retirement is a stone

More information

New Case Submission Checklist Tufts Health Plan Tufts Medicare Preferred HMO Prime For Working-Aged Employees

New Case Submission Checklist Tufts Health Plan Tufts Medicare Preferred HMO Prime For Working-Aged Employees hsainsurance.com New Case Submission Checklist Tufts Health Plan Tufts Medicare Preferred HMO Prime For Working-Aged Employees Check if Complete To ensure that your applications are processed as quickly

More information

New Employment & Sign-up Checklist for Managers and Departmental Representatives

New Employment & Sign-up Checklist for Managers and Departmental Representatives FLORIDA A&M UNIVERSITY New Employment & Sign-up Checklist for Managers and Departmental Representatives Executive Service A&P USPS OPS Faculty (Please complete Section II Only) Employee Name: Class Title:

More information

School District of Palm Beach County RETIREMENT. Human Resources CHARTING THE COURSE. Silverander, EthnoGraphics

School District of Palm Beach County RETIREMENT. Human Resources CHARTING THE COURSE. Silverander, EthnoGraphics School District of Palm Beach County Human Resources RETIREMENT CHARTING THE COURSE Silverander, EthnoGraphics Retirement is one of the most important decisions you will ever make. Whether your retirement

More information

Applying for Your IMRF Pension

Applying for Your IMRF Pension Applying for Your IMRF Pension Congratulations on your upcoming retirement! Please use this checklist when applying for IMRF retirement benefits. 1. File this form one month before your retirement date.

More information

New Employee Welcome Letter and Orientation Checklist

New Employee Welcome Letter and Orientation Checklist Lafayette DQ Restaurants P.O. Box 302 Delphi, IN 46923 Phone: (765) 447-1089 Fax: (765) 535-5001 New Employee Welcome Letter and Orientation Checklist Welcome to the DQ family! In order to start training

More information

Lyon County Human Services

Lyon County Human Services Lyon County Human Services 620 Lake Avenue, Silver Springs, NV 89429 (775) 577-5009 / (775) 577-5093 fax Appointment Date: Time: Advocate: Important: Please provide the office with all required documentation

More information

Affordable Unit Application Reserve on Salisbury

Affordable Unit Application Reserve on Salisbury Affordable Unit Application Reserve on Salisbury Holden, MA Applications must be completed and delivered by 2 pm July 1 st, 2013. MAXIMUM Household Income Limits: $45,100 (1 person), $51,550 (2 people),

More information

Welcome to Compass Medical!

Welcome to Compass Medical! ELECTRONIC FORM DISCLAIMER: Compass Medical is deeply committed to protecting our patient's rights to privacy and safeguarding patient information. Please know we are working hard to bring our patients

More information

EXCEPTIONS TO THE ABOVE CRITERIA MAY BE MADE AT THE SOLE DISCRETION OF SOTO Property Management. ADDITIONAL SECURITY DEPOSIT MAY BE REQUIRED.

EXCEPTIONS TO THE ABOVE CRITERIA MAY BE MADE AT THE SOLE DISCRETION OF SOTO Property Management. ADDITIONAL SECURITY DEPOSIT MAY BE REQUIRED. SOTO Property Solutions screens all prospective tenants. The screenings consist of rental history, employment verification, criminal background check, and credit check. Applicants must meet the following

More information

YOU PREVIOUSLY APPLIED TO CHI?

YOU PREVIOUSLY APPLIED TO CHI? Applicant Intake Form NOTE: You are NOT eligible for grant if already in contract. HAVE YOU PREVIOUSLY APPLIED TO CHI? YES NO IF YES, WERE YOU DENIED? YES NO HAVE YOU EVER RECEIVED A GRANT? YES NO PREVIOUS

More information

Montana State University MESA Program POTENTIAL PARTICIPANT APPLICATION FORM

Montana State University MESA Program POTENTIAL PARTICIPANT APPLICATION FORM Montana State University MESA Program POTENTIAL PARTICIPANT APPLICATION FORM Date: / / To ensure you qualify for the Matched Education Savings Account (MESA) Program, please read the MESA Frequently Asked

More information

Emergency Home Repair (EHR) Information & Application

Emergency Home Repair (EHR) Information & Application Emergency Home Repair (EHR) Information & Application Objective: Clearfield City has established the Emergency Home Repair (EHR) Program to provide lower income homeowners up to $3,000 in grant money to

More information

APPLICATION FOR FAIR & AFFORDABLE HOMEOWNERSHIP GATEWAY PEEKSKILL CONDOMINIUM 704 & 716 MAIN ST., CITY OF PEEKSKILL, NEW YORK

APPLICATION FOR FAIR & AFFORDABLE HOMEOWNERSHIP GATEWAY PEEKSKILL CONDOMINIUM 704 & 716 MAIN ST., CITY OF PEEKSKILL, NEW YORK APPLICATION FOR FAIR & AFFORDABLE HOMEOWNERSHIP GATEWAY PEEKSKILL CONDOMINIUM 704 & 716 MAIN ST., CITY OF PEEKSKILL, NEW YORK DEADLINE FEBRUARY 19, 2019 Mail or Hand Deliver Completed Application to: at

More information

North Carolina Department of Health and Human Services Division of Mental Health, Developmental Disabilities and Substance Abuse Services

North Carolina Department of Health and Human Services Division of Mental Health, Developmental Disabilities and Substance Abuse Services North Carolina Department of Health and Human Services Division of Mental Health, Developmental Disabilities and Substance Abuse Services 3008 Mail Service Center Raleigh, North Carolina 27699-3008 Michael

More information

Employee Data Form. [ ] ] ] [ ] ] [ ] _] _]_ ] Home Address Apt City State Zip Code County. Ethnicity: Are you Hispanic/Latino?

Employee Data Form. [ ] ] ] [ ] ] [ ] _] _]_ ] Home Address Apt City State Zip Code County. Ethnicity: Are you Hispanic/Latino? Employee Data Form Baltimore City Public Schools Office Of Human Capital 200 E. North Avenue, Room 110 Baltimore, Maryland 21202 www. s New /Rehire employees are required to complete this form as part

More information

RURAL SELF-HELP HOUSING PROGRAM Pre-Application

RURAL SELF-HELP HOUSING PROGRAM Pre-Application RURAL SELF-HELP HOUSING PROGRAM Pre-Application Self-Help Housing is a group method of home construction available to limitedincome households. Eligible households qualify for low-interest loans and work

More information

Visiting International Exchange Application

Visiting International Exchange Application Your name (What you prefer to be called) Visiting International Exchange Application Please submit all application documents and materials to Tom Janis, Int'l Programming Coordinator: Deadline for fall

More information

PRE PURCHASE APPLICATION

PRE PURCHASE APPLICATION Phone: (727) 442-7075 Fax: (727) 446-8727 www.tampabaycdc.org PRE PURCHASE APPLICATION Congratulations on taking the first steps toward becoming a homeowner! Thank you for your interest in our Home Buyer

More information

Page 1 of 20. Please return completed packet to Houston Habitat for 3750 N McCarty St., Houston, TX 77029

Page 1 of 20. Please return completed packet to Houston Habitat for 3750 N McCarty St., Houston, TX 77029 Page 1 of 20 Page 2 of 20 Houston Habitat for Humanity Family Selection Criteria YOU MUST BE A US CITIZEN OR HAVE A PERMANENT RESIDENT STATUS YOU MUST BE ON YOUR JOB FOR AT LEAST ONE YEAR YOU MUST HAVE

More information

HOME SWEET HOME COMMUNITY REDEVELOPMENT CORPORATION Rebuilding our community one day at a time Customer Intake Form

HOME SWEET HOME COMMUNITY REDEVELOPMENT CORPORATION Rebuilding our community one day at a time Customer Intake Form Customer Intake Form CUSTOMER Please print Name: City: State: Zip Code: Date of Birth: / / Social Security: - - Gender: Male Female Handicapped? Yes or No Home: ( ) - Work: ( ) - Cell: ( ) - E-mail: Race

More information

ST. LUCIE COUNTY SCHOOL BOARD SALARY SCHEDULES, SECTION 1 GENERAL PROVISIONS

ST. LUCIE COUNTY SCHOOL BOARD SALARY SCHEDULES, SECTION 1 GENERAL PROVISIONS I. Salary Schedules ST. LUCIE COUNTY SCHOOL BOARD SALARY SCHEDULES, SECTION 1 GENERAL PROVISIONS The salary schedules adopted by the School Board of Saint Lucie County are effective July 1, 2017 and continue

More information

MERCER MARKETPLACE 365 HRA INSTRUCTIONAL GUIDE

MERCER MARKETPLACE 365 HRA INSTRUCTIONAL GUIDE MERCER MARKETPLACE 365 HRA INSTRUCTIONAL GUIDE Please keep this guide in a convenient location so that you may refer to it as needed. Contact us by: Phone (toll-free): 1-866-609-4810 For deaf or hard of

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

Property Management, Inc.

Property Management, Inc. EQUAL HOUSING O P P O R T U N I T Y Justus Property Management, Inc. RENTAL APPLICATION Marketing info: How did you hear about the property? Please include a $16.00 fee for each adult household member.

More information

Homeownership Program Application

Homeownership Program Application Homeownership Program Application Coordinated by: The Homeowner Selection Committee Due before October 15, 2017 Via mail or dropped off at Habitats Headquarters Mailing Address: Habitat for Humanity Attn:

More information

MINNESOTA CRIME VICTIMS REPARATIONS CLAIM FORM Complete and submit to:

MINNESOTA CRIME VICTIMS REPARATIONS CLAIM FORM Complete and submit to: Date Received: MINNESOTA CRIME VICTIMS REPARATIONS CLAIM FORM Complete and submit to: Claim Number: (Office Use Only) Minnesota Crime Victims Reparations Board 445 Minnesota Street, Suite 2300 St. Paul

More information

Habitat for Humanity FOR HOUSING. Habitat for Humanity of Union County

Habitat for Humanity FOR HOUSING. Habitat for Humanity of Union County Habitat for Humanity Application FOR HOUSING Habitat for Humanity of Union County Habitat for Humanity Application FOR HOUSING Habitat for Humanity of Union County,Inc. P.O. Box 245 Marysville, Ohio 43040

More information

INSTRUCTIONS FOR COMPLETING DBPR ABT DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR WHOLESALE CIGARETTE PERMIT

INSTRUCTIONS FOR COMPLETING DBPR ABT DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR WHOLESALE CIGARETTE PERMIT INSTRUCTIONS FOR COMPLETING DBPR ABT- 6024 DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION FOR WHOLESALE CIGARETTE PERMIT If you have any questions or need assistance in completing this application,

More information

Southeast ID#: Name: SSN: PREVIOUS CIVIL OR COLLEGE DISCIPLINE

Southeast ID#: Name: SSN: PREVIOUS CIVIL OR COLLEGE DISCIPLINE /Student Employment Work Referral Southeast ID#: Name: SSN: STUDENT EMPLOYEE ELIGIBILITY AND RESPONSIBILITIES 1. You must complete, and have on file with Student Financial Services, employment eligibility

More information