Admission in Basic Fire Fighting Training Course at Airports Authority of India Fire Training Establishment (New Delhi & Kolkata)

Size: px
Start display at page:

Download "Admission in Basic Fire Fighting Training Course at Airports Authority of India Fire Training Establishment (New Delhi & Kolkata)"

Transcription

1 Eligibility Criteria Educational Qualification Admission in Basic Fire Fighting Training Course at Airports Authority of India Fire Training Establishment (New Delhi & Kolkata) a) 10 th Pass + 3 years approved regular Diploma in Mechanical/Automobile/ Fire with minimum 50% marks; OR b) 12 th Pass with 50% marks a) Valid Light Motor Vehicle Licence 30 years Driving License Age Physical Standard Physique :- Good Minimum Height Minimum Weight :- 167cms :- 55 kg. Chest :- a) Normal before expansion :- 81cms :- b) Minimum expansion :- 05 cms :- c)relaxation of 3 cms in height and chest measurement and proportionate relaxation in weight will be allowed to hilly area candidates on producing of Bonafide Certificates. However minimum chest expansion must be 05cms. Eye Sight:- Distance Vision :- 6/6 Near Vision Colour Vision Night blindness Field of vision Hearing Speech Refractive error :- N-5 with each eye without glasses :- Should be normal :- Absent :- Each eye should have full field of Vision :- Normal :- Normal :- No refractive error is acceptable Duration of Course Course Schedule Disqualification :- Knocking knee, bow legs, degree of squint flat footed, physical deformity, suffering from chronic diseases, any other major operation by virtue of which his physical fitness to work in fire service has been impaired will be considered as disqualification. 16 Weeks FSTC Kolkata i) 15 th March to 23 rd July, 2012 ii) 30 th July to 07 th December, 2012 FTC Delhi : i) 16 th January to 25 th May, 2012 ii) 30 th May to 09 th October, 2012 Course Fee INR 60000/- + INR taxes Extra (Excluding boarding & lodging) For details Contact Principal, FTC: FTC Delhi : (Telefax), incharge.ftc@aai.aero Principal, FSTC: FSTC Kolkata : (Telefax), Principal_fstc@yahoo.com GM(Fire), CHQ Phone : / / Extn Tele. Fax : Web site / gmfire@aai.aero Contd /-

2 Note:- 1. Candidates are advised to send their applications for basic training along with all necessary documents directly to the principal of respective fire training centres i.e. New Delhi & Kolkata, accordingly. 2. No job guarantee will be given by Airports Authority of India. 3. Admission to the Training Programme will be on the basis of Eligibility Criteria and it is up to the discretion of AAI. 4. The management will not be responsible for any serious injuries /accident, if happens, during the training period and candidate will have to submit the indemnity bond and undertaking to abide by Code of Conduct of FTC / FSTC at the time of admission. 5. Course is strictly residential. No request for exemption in this regard will be entertained.

3 AIRPORTS AUTHORITY OF INDIA FIRE TRAINING ESTABLISHMENTS AT KOLKATA AND DELHI APPLICATION FORM FOR ADMISSION IN BASIC FIRE TRAINING COURSE Affix recent colour passport size photograph 1. Name: Miss/Mrs./Mr. 2. Father s Name : 3. Address for Correspondence: District : Pin Code Tel ID : 4. Permanent Address: District : Pin Code Tel 5. Date of Birth: Date Month Year 6. Nationality: 7. Religion : 8. Sex Code : 9. Martial Status Code: Single Married Contd..2/-

4 Education Qualification: (Attested copies of certificate to be attached) S. Exam Passed No. 1 Matric /S.S.C / 10 th Board/University Year of Passing Division/ Grade % of marks Subjects 2 HSSC / 12 th 3 Diploma in Mechanical/Automobile/ Fire 4 Others 11. Current Heavy Vehicle Driving Licence Number : i. Name of the Issuing Authority : ii. Date of issue : iii. Valid upto : 12. Physical Standard (Doctor s Certificate to be attached) a) Height : Cms. b) Weight : Kg. c) Chest Normal : Cms. d) Chest Expansion : Cms. e) Eye Sight Distant Vision without glasses : f) Eye Sight Near vision without glasses : g) Colour Blindness : h) Night Blindness : i) Hearing : j) Speech : i) Knocking Knee : j) Bowlegs : k) Degree of Squint : l) Flat Footed : m) Physical Deformity : n) Suffering from Chronic Disease : o) Whether undergone any surgical operation (s): The candidate is physically & medically fit to undergo the training. 1) Name & Signature of the Registered : Medical Practioner (with seal) 2) Registration No. : Signature of the Applicant Contd 3/-

5 - 3 - FOR OFFICE USE Application received on Admission for BTC Course (Period) Fee Receipt No. Roll NO. allotted Remarks In-Charge for admission Contd 4/-

6 - 4 - INDEMNITY BOND I, hereby submit that, in case of any physical / mental injury during training period for Basic Training Course in Airports Authority of India Fire Training Establishment, nobody shall be held responsible for the same and I shall have no claim whatsoever to this effect. Signature : Name: Address: Date To The In-Charage/Principal FIRE SERVICE TRAINING CENTRE Airports Authority of India Narayanpur, Kolkata The In-Charge/Principal FIRE TRAINING CENTRE Airports Authority of India Gurgaon Road, New Delhi

Admission In Basic Fire Fighting Training Course at Airports Authority of India Fire Training Establishment (Delhi & Kolkata) Eligibility Criteria

Admission In Basic Fire Fighting Training Course at Airports Authority of India Fire Training Establishment (Delhi & Kolkata) Eligibility Criteria Admission In Basic Fire Fighting Training Course at Airports Authority of India Fire Training Establishment (Delhi & Kolkata) Eligibility Criteria Qualification Passed 10+2 Essential Requirements Should

More information

भ रत य व म नपत तन प र ध करण

भ रत य व म नपत तन प र ध करण भ रत य व म नपत तन प र ध करण AIRPORTS AUTHORITY OF INDIA फ यर सव स ट र नन ग स टर, क लक त FIRE SERVICE TRAINING CENTER, KOLKATA NOTICE INVITING QUOTATION For ENGAGEMENT OF ACCREDITED CERTIFYING BODY FOR

More information

National Certification Board

National Certification Board ISNT Membership No. National Certification Board ISNT Level III Certification Application ID No: Non ISNT Members should fill in the enclosed Membership Form and Select the option in the table below for

More information

APPLICATION FOR NDT CERTIFICATION (Please fill the Application form in Capital letters or by Typing)

APPLICATION FOR NDT CERTIFICATION (Please fill the Application form in Capital letters or by Typing) Application Form / File No.: Certificate No.: APPLICATION FOR NDT CERTIFICATION (Please fill the Application form in Capital letters or by Typing) Name : Age & Date of Birth : Permanent Address : Affix

More information

भ रत य वम नपत तन धकरण

भ रत य वम नपत तन धकरण Airports Authority of India (A mini Ratna PSU) wishes to engage Physiotherapist, on part time basis, for its employees at Medical Centre, INA Colony, New Delhi. Interested and eligible candidates may appear

More information

Health Examination Guidelines For Entry Into Universiti Tunku Abdul Rahman

Health Examination Guidelines For Entry Into Universiti Tunku Abdul Rahman Health Examination Guidelines For Entry Into Universiti Tunku Abdul Rahman 1. Read the instructions carefully before filling in the form. 2. The form has 4 sections: (a) Section 1 (Parts A and B) to be

More information

(First name) (Middle name) (Family name) 2. Date of Birth & Age: years. 3. Sex: M / F D M Y. 4. Religion: Caste: Nationality:

(First name) (Middle name) (Family name) 2. Date of Birth & Age: years. 3. Sex: M / F D M Y. 4. Religion: Caste: Nationality: RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA APPLICATION FORM FOR FELLOWSHIP IN HIV PART - A 1. Applicants full name: (in capital letters) (First name) (Middle name) (Family name) Affix recent

More information

GUIDELINES TO FILL IN HEALTH EXAMINATION REPORT

GUIDELINES TO FILL IN HEALTH EXAMINATION REPORT GUIDELINES TO FILL IN HEALTH EXAMINATION REPORT 1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM. 2. PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE. 3. PLEASE WRITE IN CAPITAL LETTERS.

More information

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS 1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM. 2. PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE.

More information

HEALTH EXAMINATION GUIDELINES

HEALTH EXAMINATION GUIDELINES HEALTH EXAMINATION GUIDELINES 1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM. 2. PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE. 3. PLEASE WRITE IN CAPITAL LETTERS. 4. THIS FORM HAS

More information

All India Institute of Medical Sciences, Bhubaneswar At: Sijua, Post: Dumuduma, Bhubaneswar

All India Institute of Medical Sciences, Bhubaneswar At: Sijua, Post: Dumuduma, Bhubaneswar All India Institute of Medical Sciences, Bhubaneswar At: Sijua, Post: Dumuduma, Bhubaneswar - 751019 AIIMS/BBSR/ADMIN/ICMR/622 Date : 19/06/2018 WALK-IN INTERVIEW Eligible candidates are invited to attend

More information

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS 1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM. 2. PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE.

More information

Manipal College of Dental Sciences, Manipal

Manipal College of Dental Sciences, Manipal Manipal College of Dental Sciences, Manipal 1. Fees & Mode of Payment 1A. General Category 1B. Foreign / NRI Category 1C. Mode of Payment https://manipal.edu/mcodsmanipal 1A. FEES: GENERAL CATEGORY Course

More information

Fellowship Program On Basic and Advanced Acupuncture

Fellowship Program On Basic and Advanced Acupuncture Fellowship Program On Basic and Advanced Acupuncture National Institute of Naturopathy Ministry of AYUSH, Government of India Matoshree Ramabai Ambedkar Road, Pune-411001, Maharashtra Aim The program is

More information

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS 1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM. 2. PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE

More information

APPLICATION PACK CHECKLIST

APPLICATION PACK CHECKLIST APPLICATION PACK CHECKLIST Instructions Please tick if the relevant section is completed and included: Employment Application WorkCover Declaration Immunisation Record Form Record of Vaccinations Received

More information

The District Medical Officer/ Chairman Medical Board,

The District Medical Officer/ Chairman Medical Board, Annexure-III MTNL/R&E/1(42)/Rep/2011 Dated:25.10.2012 To, The District Medical Officer/ Chairman Medical Board, Sub: Medical Examination of the candidates for appointment as Junior Accounts Officer in

More information

Postgraduate Course MDS Master of Dental Surgery

Postgraduate Course MDS Master of Dental Surgery Postgraduate Course MDS Master of Dental Surgery Specialities for the MDS Degree Oral Medicine & Radiology Oral & Maxillofacial Surgery Orthodontics & Dentofacial Orthopaedics Paedodontics & Preventive

More information

RAILWAY RECRUITMENT BOARD, BHOPAL

RAILWAY RECRUITMENT BOARD, BHOPAL RAILWAY RECRUITMENT BOARD, BHOPAL GOVT. OF INDIA (MINISTRY OF RAILWAYS) East Railway Colony,Bhopal-462010, Madhya Pradesh Website : www.rrbbpl.nic.in E-mail : msrrbbpl.@gmail.com Phone No : (0755) 2746660

More information

Technical Meeting on the Security of Nuclear and other Radioactive Material in Transport

Technical Meeting on the Security of Nuclear and other Radioactive Material in Transport Technical Meeting on the Security of Nuclear and other Radioactive Material in Transport IAEA Headquarters Vienna, Austria 9 July 2018 13 July 2018 Ref. No.: EVT1703390 Information Sheet A. Introduction

More information

HEALTH EXAMINATION GUIDELINES

HEALTH EXAMINATION GUIDELINES HEALTH EXAMINATION GUIDELINES 1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM. 2. PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE. 3. PLEASE WRITE IN CAPITAL LETTERS. 4. THIS FORM HAS

More information

PLEASE COMPLETE ALL RELEVANT SECTIONS OF THIS FORM

PLEASE COMPLETE ALL RELEVANT SECTIONS OF THIS FORM APPLICATION FOR INCLUSION IN THE DENTAL LIST OF THE HEALTH AND SOCIAL CARE BOARD PLEASE COMPLETE ALL RELEVANT SECTIONS OF THIS FORM Return the completed form to the Health and Social Care Board local office

More information

AMERICAN BOARD OF ADOLESCENT PSYCHIATRY

AMERICAN BOARD OF ADOLESCENT PSYCHIATRY AMERICAN BOARD OF ADOLESCENT PSYCHIATRY SUPPORTED BY THE AMERICAN SOCIETY FOR ADOLESCENT PSYCHIATRY Candidate Guide & Certification Examination Application American Society For Adolescent Psychiatry P.O.

More information

Ophthalmologist/Optometrist/Low Vision Clinic Report. 1.1 Title: (Mr/Mrs/Miss, etc) Surname: Full Names:. 1.4 Physical Address:.

Ophthalmologist/Optometrist/Low Vision Clinic Report. 1.1 Title: (Mr/Mrs/Miss, etc) Surname: Full Names:. 1.4 Physical Address:. OPTIMA COLLEGE COMPUTER SKILLS PROGRAMME APPLICATION FORM PLEASE NOTE: Incomplete applications will not be considered. Please ensure that the following are attached: Medical Report Ophthalmologist/Optometrist/Low

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PT Revive by Exam Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC Passing:

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PT Endorsement Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC Passing:

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Assistant Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Assistant Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PTA Revive by Exam Application Examination Date: ID Number: Exam Form Number: SCORES: Scaled: / / Raw: / / NC Passing: Scaled:

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PT Exam Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC Passing: Scaled:

More information

3. How Long Has This Been An Issue?

3. How Long Has This Been An Issue? NEW PATIENT INTAKE FORM Aspire Chiropractic 124 W Harwood Rd. Ste. B Hurst, TX 76054 Name: Occupation: DOB: Age: Sex: Male Female Employer: Marital Status: Single Married Other Name/Age of Kids: Phone:

More information

Baby-Sitting - $20 Per Day/Per Nanny (local clients) Less than 24 hours notice $30 Per Day/Per Nanny. Hotel Overnight Sitting - $35 per Day/Per Nanny

Baby-Sitting - $20 Per Day/Per Nanny (local clients) Less than 24 hours notice $30 Per Day/Per Nanny. Hotel Overnight Sitting - $35 per Day/Per Nanny ALL ABOUT NANNIES BUSINESS PHONE: 602-266-9116 BUSINESS FACSIMILE: 602-266-9787 BUSINESS EMAIL: ADMIN@ALLABOUTNANNIESINC.COM TEMPORARY, BABY-SITTING, HOTEL & ON-CALL AS NEEDED Mother s Full Name: Place

More information

International School Bangkok Physical Examination Report (New Student)

International School Bangkok Physical Examination Report (New Student) Physical Examination Report (New Student) A registered Medical Practitioner must complete this form. The examination should be completed no more than 6 months prior to commencement at ISB and submitted

More information

ICMR- NATIONAL INSTITUTE OF VIROLOGY 20-A, Dr. Ambedkar Road, Post Box No.11, Pune Walk in Interview/Written Test Advt. No.

ICMR- NATIONAL INSTITUTE OF VIROLOGY 20-A, Dr. Ambedkar Road, Post Box No.11, Pune Walk in Interview/Written Test Advt. No. ICMR- NATIONAL INSTITUTE OF VIROLOGY 20-A, Dr. Ambedkar Road, Post Box No.11, Pune 411 001 Walk in Interview/Written Test Advt. No. 05/2018-19 Following positions would be filled up purely on temporary

More information

Part 1 : Personal Information (This part is to be completed by the applicant)

Part 1 : Personal Information (This part is to be completed by the applicant) MEDICAL REPORT FOR FOREIGN WORKER FOR EMPLOYMENT IN BRUNEI DARUSSALAM (in accordance with The Infectious Diseases Order; Immigration Act and Labor Act of the Statutes of Brunei Darussalam) photo Accreditation

More information

DENTAL CLAIM FORM. Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines

DENTAL CLAIM FORM. Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines DENTAL CLAIM FORM Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines OFFICE USE ONLY Claim number Reference COMPLETE THIS FORM IF You

More information

Your registration is confirmed once you have completed the form. We will not be sending any further notice.

Your registration is confirmed once you have completed the form. We will not be sending any further  notice. Diploma in Management Studies (DMS) Orientation Schedule April 2018 Intake DATE TIME VENUE DETAILS IMPORTANT INFORMATION 19 March SIM HQ, Blk A, Medical Check-up This medical service is provided by SATA

More information

Technical Meeting on Strengthening Quality Assurance/Quality Control Protocols in Radiation Facilities Through Dosimetry Inter-comparison

Technical Meeting on Strengthening Quality Assurance/Quality Control Protocols in Radiation Facilities Through Dosimetry Inter-comparison Technical Meeting on Strengthening Quality Assurance/Quality Control Protocols in Radiation Facilities Through Dosimetry Inter-comparison IAEA Headquarters Vienna, Austria 1 October 2018 to 5 October 2018

More information

Certificate IV in Mental Health Peer Work CHC43515 Scholarships Application Form

Certificate IV in Mental Health Peer Work CHC43515 Scholarships Application Form Mental Health Coordinating Council (MHCC) Learning & Development ABN 592 791 68647 RTO Code 91296 Certificate IV in Mental Health Peer Work CHC43515 Scholarships Application Form MHCC is offering scholarship

More information

BERMUDA DENTAL TECHNICIANS REGULATIONS 1962 BX 6 / 1962

BERMUDA DENTAL TECHNICIANS REGULATIONS 1962 BX 6 / 1962 QUO FA T A F U E R N T BERMUDA DENTAL TECHNICIANS REGULATIONS 1962 BX 6 / 1962 TABLE OF CONTENTS 1 2 3 4 5 6 7 8 9 10 11 12 15 Citation Interpretation Unqualified persons; offences Register of dental technicians

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PT Revive by Endorsement Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC

More information

DENTAL CLAIM FORM. Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines.

DENTAL CLAIM FORM. Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines. DENTAL CLAIM FORM Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines Office Use Only Claim number Reference Complete this form if You

More information

2010 Sharing Hope Program for men

2010 Sharing Hope Program for men 2010 Sharing Hope Program for men Criteria and Application Made possible by participating sperm banks and fertility centers Program Overview Goal Cancer patients have little opportunity to save for the

More information

DIOCESE OF CORPUS CHRISTI

DIOCESE OF CORPUS CHRISTI Office of Youth Ministry DIOCESE OF CORPUS CHRISTI PO Box 2620 Corpus Christi, Texas 78403 (361) 882-6191 Fax (361) 693-6787 www.diocesecc.org/youth YouthOffice@diocesecc.org DIOCESAN CONFIRMATION RETREATS

More information

PATIENT ENTRANCE FORM

PATIENT ENTRANCE FORM PATIENT ENTRANCE FORM Name _ Date Address City/ Province Postal Code Home Telephone Work Telephone Email Address Would like email reminders for appointments? Yes No Date of Birth (Day/Month/Year) Age Marital

More information

JHARKHAND STATE SPORTS PROMOTION SOCIETY

JHARKHAND STATE SPORTS PROMOTION SOCIETY JHARKHAND STATE SPTS PROMOTION SOCIETY JHARKHAND (A CCL- State STATE Govt. of SPTS Jharkhand PROMOTION joint initiative) C/o Mega Sports Complex, SOCIETY Khelgaon, Hotwar, Ranchi-835217 (A CCL- State Tel:

More information

Dear Family or Referral:

Dear Family or Referral: Dear Family or Referral: APPLICATION for: South Carolina School for the Deaf and the Blind 355 Cedar Springs Road, Spartanburg SC 29302 Phone: (864) 577-7540 Toll Free: (888) 447-2732 Fax: (864) 577-7561

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Assistant Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Assistant Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PTA Endorsement Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC Passing:

More information

MODIFICATION OF APPLICATION TO BECOME A LICENSED PRODUCER UNDER THE ACCESS TO CANNABIS FOR MEDICAL PURPOSES REGULATIONS

MODIFICATION OF APPLICATION TO BECOME A LICENSED PRODUCER UNDER THE ACCESS TO CANNABIS FOR MEDICAL PURPOSES REGULATIONS MODIFICATION OF APPLICATION TO BECOME A LICENSED PRODUCER UNDER THE ACCESS TO CANNABIS FOR MEDICAL PURPOSES REGULATIONS (ACMPR) (Disponible en français) This form should be used if you already submitted

More information

Last Name First Name MI: Address City State Zip. Referring Provider. Employer Address. Emergency Contact Relationship Phone. ID # Group # ID # Group #

Last Name First Name MI: Address City State Zip. Referring Provider. Employer Address. Emergency Contact Relationship Phone. ID # Group # ID # Group # Patient Demographic o New Patient o Return Patient o Update Account #: Last Name First Name MI: Address City State Zip Home Phone o OK to Leave Msg. Work Phone o OK to Leave Msg. Cell Phone o OK to Leave

More information

APPLICATION 2018 Confidence Camp for Kids Elementary Program

APPLICATION 2018 Confidence Camp for Kids Elementary Program APPLICATION 2018 Confidence Camp for Kids Elementary Program For ages 5-11 Note: Applications will be reviewed based on the order received. Date: Child s Name Date of Birth Male Female Home Address City

More information

Dear Applicant, If you have any questions, feel free to call (509) Sincerely, Steven Hansen WSU PD Assistant Chief

Dear Applicant, If you have any questions, feel free to call (509) Sincerely, Steven Hansen WSU PD Assistant Chief Dear Applicant, Thank you for expressing interest in the Washington State University Police Department Internship Program. The Program was developed by the WSU Police Department to offer an opportunity

More information

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS LAMPIRAN A 1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM. 2. PLEASE FILL IN THE FORM IN ENGLISH

More information

Phlebotomy Training Pre-Admission Application

Phlebotomy Training Pre-Admission Application Student, Thank you for your interest in our continuing education healthcare courses. Below you will find pre-admission information relevant to our. This application packet must be completed and returned

More information

Police Officer Borough of Dormont Police Department

Police Officer Borough of Dormont Police Department Police Officer Borough of Dormont Police Department The Borough of Dormont Police Department is a local police department which provides police protection and life safety services to the residents of the

More information

OCCUPATIONAL HEALTH PROTOCOL

OCCUPATIONAL HEALTH PROTOCOL Faculty of Medicine and Surgery OCCUPATIONAL HEALTH PROTOCOL (Applicable to applicants for the Doctor of Medicine and Surgery M.D. - Degree Course) Applicability for Courses commencing in October 2015

More information

DIOCESE OF CORPUS CHRISTI

DIOCESE OF CORPUS CHRISTI Office of Youth Ministry DIOCESE OF CORPUS CHRISTI 620 Lipan St. Corpus Christi, Texas 78401 (361) 882-6191 Fax (361) 693-6787 www.diocesecc.org/youth YouthOffice@diocesecc.org DIOCESAN CONFIRMATION RETREATS

More information

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS

HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS LAMPIRAN A HEALTH EXAMINATION GUIDELINES FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS 1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM. 2. PLEASE FILL IN THE FORM IN ENGLISH

More information

KENTUCKY ADULT PEER SUPPORT SPECIALIST TRAINING:

KENTUCKY ADULT PEER SUPPORT SPECIALIST TRAINING: KENTUCKY ADULT PEER SUPPORT SPECIALIST TRAINING: INFORMATION SHEET/CHECKLIST Description (908 KAR 2:220): Peer support is the social and emotional support provided by persons with a mental health condition

More information

UNE EVENT REGISTRATION FORM

UNE EVENT REGISTRATION FORM UNE EVENT REGISTRATION FORM *Must be lodged with the UNE Life Event Administration at least 7 days prior to event for events 100 people This form is applicable

More information

SAVE THE DATE!!!!

SAVE THE DATE!!!! www.mhrecovery.org SAVE THE DATE!!!! CERTIFIED PEER SPECIALIST TRAINING IS COMING TO HARRISBURG, PA!!! FACILITATED BY COPELAND CENTER NATIONAL DIRECTOR FOR WELLNESS & EDUCATION, GINA KAYE CALHOUN NOW ACCEPTING

More information

APPLICATION FOR CHILD SUPPORT SERVICES NON PUBLIC ASSISTANCE APPLICANT/RECIPIENT

APPLICATION FOR CHILD SUPPORT SERVICES NON PUBLIC ASSISTANCE APPLICANT/RECIPIENT Warren County CSEA PO Box 440 500 Justice Drive Lebanon, OH 45036 (513) 695 1580 (800) 644 2732 Name of Applicant: Address: City, State, & Zip: Date: Application Number: APPLICATION FOR CHILD SUPPORT SERVICES

More information

OPTIMA COLLEGE CONTACT CENTRE SUPPORT APPLICATION FORM

OPTIMA COLLEGE CONTACT CENTRE SUPPORT APPLICATION FORM OPTIMA COLLEGE CONTACT CENTRE SUPPORT APPLICATION FORM LEARNING PROGRAMME APPLIED FOR: A: SKILLS PROGRAMME (2 MONTHS) OR B: LEARNERSHIP PROGRAMME (12 MONTHS) PLEASE NOTE: Incomplete applications will not

More information

Care Champion DIAMOND

Care Champion DIAMOND Care Champion DIAMOND A Care Champion Diamond is an individual* who undertakes to raise a minimum of Rs 4 lakh in donations for a chosen Civil Society Organisation (CSO (NGO)/ NGO). In order to register,

More information

North Carolina Peer Support Specialist Training Program Application

North Carolina Peer Support Specialist Training Program Application Vaya Health North Carolina Peer Support Specialist Training Program Application What does the training require? Vaya Health s North Carolina Peer Support Specialist Training is a 40-hour program that takes

More information

National Institute for Empowerment of Persons with Multiple Disabilities (Divyangjan) (NIEPMD)

National Institute for Empowerment of Persons with Multiple Disabilities (Divyangjan) (NIEPMD) National Institute for Empowerment of Persons with Multiple Disabilities (Divyangjan) (NIEPMD) (Department of Empowerment of persons with Disabilities (Divyangjan), Ministry of Social Justice & Empowerment,

More information

Application for registration in New Zealand for holders of New Zealand qualifications

Application for registration in New Zealand for holders of New Zealand qualifications Application for registration in New Zealand for holders of New Zealand qualifications May 2018 This application is to be used by holders of prescribed New Zealand qualifications who are seeking eligibility

More information

Grand-parenting and General Registration Eligibility Registration Standard Requirements

Grand-parenting and General Registration Eligibility Registration Standard Requirements Grand-parenting and General Registration Eligibility Registration Standard Requirements Preamble General registration is available to practitioners who apply their skills and knowledge in any area relevant

More information

Town of Norwell Fire Department. Fire Fighter Entrance Examination Registration Information

Town of Norwell Fire Department. Fire Fighter Entrance Examination Registration Information Town of Norwell Fire Department Fire Fighter Entrance Examination Registration Information Exam date: Wednesday, August 23, 2017 Exam Location: Cushing Memorial Center 675 Main Street Norwell MA Check-in

More information

ARKANSAS STATE BOARD OF ATHLETIC TRAINING 9 SHACKLEFORD PLAZA, SUITE 3 LITTLE ROCK, AR 72211

ARKANSAS STATE BOARD OF ATHLETIC TRAINING 9 SHACKLEFORD PLAZA, SUITE 3 LITTLE ROCK, AR 72211 ARKANSAS STATE BOARD OF ATHLETIC TRAINING 9 SHACKLEFORD PLAZA, SUITE 3 LITTLE ROCK, AR 72211 Application Instructions for Athletic Trainer Licensure/Temporary Permit Education: Athletic trainers seeking

More information

Kentucky Peer Support Specialist Training Registration and Application Procedures

Kentucky Peer Support Specialist Training Registration and Application Procedures Kentucky Peer Support Specialist Training Registration and Application Procedures What is Kentucky Peer Support Specialist training? Bluegrass.org is approved by the Kentucky Department of Behavioral Health

More information

KENTUCKY ADULT PEER SUPPORT SPECIALIST TRAINING:

KENTUCKY ADULT PEER SUPPORT SPECIALIST TRAINING: KENTUCKY ADULT PEER SUPPORT SPECIALIST TRAINING: DESCRIPTION, QUALIFICATIONS & RESPONSIBILITIES Description (908 KAR 2:220): Peer support is the social and emotional support provided by persons with a

More information

Application for Special Licence (for premises)

Application for Special Licence (for premises) District Office 15 Galileo Street Private Bag 544 Ngaruawahia 3742 Huntly Area Office 142 Main Street 0800 492 452 Raglan Area Office 7 Bow Street 07 825 8129 Tuakau Area Office 2 Dominion Road 0800 492

More information

THIS FORM IS TO BE COMPLETED BY CANDIDATE.

THIS FORM IS TO BE COMPLETED BY CANDIDATE. THIS FORM IS TO BE COMPLETED BY CANDIDATE. Information requested on this Candidate Pre-Placement Health Questionnaire ( Questionnaire ) is collected pursuant to Saudi Arabian Oil Company ( Saudi Aramco

More information

STUDY CLUB INFORMATION GUIDE

STUDY CLUB INFORMATION GUIDE THE COLLEGE OF DENTAL HYGIENISTS OF BRITISH COLUMBIA 600-3795 Carey Road Telephone (250) 383 4101 Victoria, British Columbia V8Z 6T8 Facsimile (250) 383 4144 STUDY CLUB INFORMATION GUIDE Beginning in 2016,

More information

APPLICATION FOR CIAPP CERTIFICATION

APPLICATION FOR CIAPP CERTIFICATION APPLICATION F CIAPP CERTIFICATION NAME E-MAIL POSTAL ADDRESS: Street City Province Postal Code TELEPHONE (WK HOME) I hereby apply for CIAPP certification in the category checked below. (For qualifications

More information

FULL REGISTRATION (365-DAY RULE EXEMPT) APPLICATION FOR PATHWAY 1

FULL REGISTRATION (365-DAY RULE EXEMPT) APPLICATION FOR PATHWAY 1 THE COLLEGE OF DENTAL HYGIENISTS OF BRITISH COLUMBIA Suite 600, 3795 Carey Road Telephone: (250) 383-4101 Victoria, British Columbia, V8Z 6T8 Facsimile: (250) 383-4144 www.cdhbc.com Email: cdhbc@cdhbc.com

More information

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT DR. ANN IZARD, B.COMM, DC DOCTOR OF CHIROPRACTIC 4353 HASTINGS STREET BURNABY, BC V5C 2J7 TEL: 604.293.2941 FAX: 604.298.2941 WWW.BHIHC.COM WWW.ANNIZARD.COM FULL NAME: DATE OF BIRTH (DD/MM/YYYY): STREET

More information

U. T. ADMINISTRATION OF DAMAN & DIU OFFICE OF THE HEAD OF SPORTS, SPORTS CLUB, MOTI DAMAN.

U. T. ADMINISTRATION OF DAMAN & DIU OFFICE OF THE HEAD OF SPORTS, SPORTS CLUB, MOTI DAMAN. U. T. ADMINISTRATION OF DAMAN & DIU OFFICE OF THE HEAD OF SPORTS, SPORTS CLUB, MOTI DAMAN. Tender Notice No. : DMN/SPORTS/GYM/2006-07/ Dt. 18/03/20. TENDER NOTICE On behalf of the President of India, Head

More information

Centre for Neuroscience Indian Institute of Science, Bangalore

Centre for Neuroscience Indian Institute of Science, Bangalore Centre for Neuroscience Indian Institute of Science, Bangalore 560012 Adv. No. 003 The Centre for Neuroscience at the Indian Institute of Science seeks to recruit personnel for the following positions

More information

Notification of Alternative Means of Compliance

Notification of Alternative Means of Compliance United Kingdom Civil Aviation Authority Safety Regulation Group Licensing & Training Standards Notification of Alternative Means of Compliance Regulation Reference: COMMISSION REGULATION (EU) No 290/2012

More information

Criteria and Application for Men

Criteria and Application for Men Criteria and Application for Men Return completed form via fax or email to LIVESTRONG Foundation attn LIVESTRONG Fertility Fax 512.309.5515 email Cancer.Navigation@LIVESTRONG.org Made possible by participating

More information

Application for Cadet Membership

Application for Cadet Membership Application for Cadet Membership 275 West Main Street P.O. Box 309 Braidwood, IL 60408 815-458-2000 Name: (Print Neatly) Introduction The Braidwood Fire Department consists of dedicated men and women who

More information

The Courageous Leadership Conference

The Courageous Leadership Conference The 2015 OESCA Spring Conference Exhibitor Packet The Courageous Leadership Conference April 14 and 15, 2015 DoubleTree by Hilton, Columbus-Worthington 175 Hutchinson Avenue Columbus, Ohio 43235 614.885.3334

More information

Lions Young Leaders in Service Awards

Lions Young Leaders in Service Awards LIONS CLUBS INTERNATIONAL Lions Young Leaders in Service Awards CHALLENGING YOUTH TO SERVE MD 105 LIONS CLUB GUIDE 1 Updated June 2016 CONTENTS Introduction to the award page 3 Benefits for young people

More information

CHILD AND ADULT CARE FOOD PROGRAM ADMINISTRATIVE REVIEW PROCEDURES

CHILD AND ADULT CARE FOOD PROGRAM ADMINISTRATIVE REVIEW PROCEDURES CHILD AND ADULT CARE FOOD PROGRAM ADMINISTRATIVE REVIEW PROCEDURES The regulations and guidelines of the Child and Adult Care Food Program (CACFP or Program) under the Food and Nutrition Service (FNS)

More information

N E W Y O R K M E D I C A L C O L L E G E A M E M B E R O F T H E T O U R O C O L L E G E A N D U N I V E R I S T Y S Y S T E M

N E W Y O R K M E D I C A L C O L L E G E A M E M B E R O F T H E T O U R O C O L L E G E A N D U N I V E R I S T Y S Y S T E M N E W Y O R K M E D I C A L C O L L E G E A M E M B E R O F T H E T O U R O C O L L E G E A N D U N I V E R I S T Y S Y S T E M HEALTH SERVICES BASIC SCIENCES BUILDING VALHALLA, NEW YORK 10595 TEL 914-594-4234

More information

MEDICAL FITNESS STANDARD FOR PERSONAL TRACK SAFETY CERTIFICATION

MEDICAL FITNESS STANDARD FOR PERSONAL TRACK SAFETY CERTIFICATION MEDICAL FITNESS STANDARD FOR PERSONAL TRACK SAFETY CERTIFICATION Please refer to www.irishrail.ie for latest version Page 1 of 7 Contents: 1 Scope 3 2 Implementation 4 Appendix 1 LEVEL 3 MEDICAL ASSESSMENT

More information

P.O. Box Austin, Texas Phone: Fax: Texas Society of Infection Control & Prevention

P.O. Box Austin, Texas Phone: Fax: Texas Society of Infection Control & Prevention Texas Society of Infection Control & Prevention P.O. Box 341357 Austin, Texas 78734 Phone: 512-722-3717 Fax: 512-722-3608 The Texas Society of Infection Control & Prevention (TSICP) is looking forward

More information

CLIENT PROCEDURE FOR ANNUAL APPROVAL OF SHIP REPAIR COMPANIES

CLIENT PROCEDURE FOR ANNUAL APPROVAL OF SHIP REPAIR COMPANIES CLIENT PROCEDURE FOR ANNUAL APPROVAL OF SHIP REPAIR COMPANIES 1.0 PURPOSE Safe work environment is essential for performing all kinds of ship repair operations. In this regard and to enable safe and smooth

More information

Hear land Men s Recovery Center

Hear land Men s Recovery Center Hear land Men s Recovery Center Page 1 of 6 Please read and follow these important guidelines: 1. Complete the 5-page application. Mail or fax it back to us at the address or number above, along with copies

More information

Membership Package Checklist

Membership Package Checklist Membership Package Checklist Name: Date: Phone number: Email: Please check that your membership package includes the following: Application for Registration signed and dated Code of Conduct read, checked

More information

BERMUDA DENTAL HYGIENISTS REGULATIONS 1950 SR&O 37 / 1950

BERMUDA DENTAL HYGIENISTS REGULATIONS 1950 SR&O 37 / 1950 QUO FA T A F U E R N T BERMUDA DENTAL HYGIENISTS REGULATIONS 1950 SR&O 37 / 1950 [made under section 28 of the Dental Practitioners Act 1950 and brought into operation on 11 December 1950] TABLE OF CONTENTS

More information

THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH IMPORTANT ANNOUNCEMENT ON THE DISCONTINUATION OF THE PART I EXAMINATION

THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH IMPORTANT ANNOUNCEMENT ON THE DISCONTINUATION OF THE PART I EXAMINATION THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH IMPORTANT ANNOUNCEMENT ON THE DISCONTINUATION OF THE PART I EXAMINATION Part I has been removed from this examination. The topics normally covered in the Part

More information

Come for a FREE foot screening and fitting with or STEP foot orthotics

Come for a FREE foot screening and fitting with or STEP foot orthotics Ankle or Instability Are you struggling with: Are your kids struggling with: Poor coordination littlesteps QUADRA Call for an appointment or for more information Come for a FREE foot screening and fitting

More information

The Kansas State Deaf-Blind Fund: Frequently Asked Questions and Answers

The Kansas State Deaf-Blind Fund: Frequently Asked Questions and Answers The Kansas State Deaf-Blind Fund: Frequently Asked Questions and Answers Early Childhood, Special Education, and Title Services An Equal Employment/Educational Opportunity Agency The Kansas State Department

More information

FACILITATOR TRAINING. TO REGISTER See pages 2-7 for more information and to register

FACILITATOR TRAINING. TO REGISTER See pages 2-7 for more information and to register FACILITATOR TRAINING DATES & LOCATIONS Wednesday, September 14, 2016 Chicago, IL Wednesday, November 9, 2016 Springfield, IL Wednesday, November 16, 2016 Chicago, IL* Wednesday, March 15, 2017 Chicago,

More information

have completed a physical exam on Print Physicians Name on. Name of Patient

have completed a physical exam on Print Physicians Name on. Name of Patient This form must be filled out by the physician that completed the physical and returned to the ATP Director by the patient. This form will be kept on record in the students permanent program file. Please

More information

Hospital-based Massage Training Program Admissions Check List

Hospital-based Massage Training Program Admissions Check List Hospital-based Massage Training Program Admissions Check List You will be required to provide the following before deadline start date of class: A copy of your massage therapist license from the state

More information

Information for applicants for Special Licence

Information for applicants for Special Licence Information for applicants for Special Licence A building consent may be required before a special licence is issued if you intend to use a building that is not normally used as a licensed premises and/or

More information