zilongwang/ReadingBank huggingface dataset:
Share how the equipment will improve participation, food safety, energy efficiency, nutrition and quality of meals, and/or promote smarter lunchrooms. Missing 0 Deficient 1 Unsatisfactory 2 Emerging 3 Proficient 4 Exemplary 5 How the equipment will improve at least one of the identified areas is not addressed. How the equipment will improve one or more of the identified areas is included but is not adequately addressed. How the equipment will improve the quality of meals is identified and is adequately addressed. How the equipment will improve food safety and nutrition and quality of meals is identified and is adequately addressed. How the equipment will improve participation, food safety, and nutrition and the quality of meals is identified and is adequately addressed. How the equipment will improve all of the identified areas is identified and is adequately addressed. SCORE FOR 3: ________ 4 Identify how the equipment will be utilized in the SBP, NSLP, ASCP, and/or FFVP. Missing 0 Deficient 1 Unsatisfactory 2 Emerging 3 Proficient 4 Exemplary 5 The programs in which the equipment will be used is not identified and/or how it will be utilized is not addressed. How the equipment will be utilized is addressed. But the programs in which the equipment will be utilized is not identified. The programs identified were ASCP or the FFVP. How the equipment will be utilized in these programs is adequately addressed. The program identified is the NSLP. How the equipment will be utilized in the NSLP is adequately addressed. The programs identified are the NSLP and SBP. How the equipment will be utilized in these programs is adequately addressed. The programs identified are the SBP, NSLP, and the ASCP or FFVP. How the equipment will be utilized in these programs is adequately addressed. FOR 4: ________
6) Identify your timeline to complete the procurement and expenditure activities by Sept. 30, 2020. Missing 0 Deficient 1 Unsatisfactory 2 Emerging 3 Proficient 4 Exemplary 5 The timeline for completion of procurement and expenditure of funds is not provided. A general statement regarding a timeline is provided but no information is provided on procurement. A timeline is not provided and only general information on the procurement process is described. The timeline for completion of the expenditure activities is provided and indicates completion will be by Sept. 30, 2020. Only limited information on the procurement process that will be used is described. A general timeline that outlines the procurement process that will be used and how expenditure activities will be completed by Sept. 30, 2020 is provided. A detailed timeline is provided that includes specific dates in which tasks will be completed, the procurement method is clearly identified and it is clearly stated that expenditure activities will be completed by Sept. 30, 2020 SCORE FOR 6: ________ TOTAL SCORE: _____________
Application for Employment Classified Staff ________________ (Date of Application) ____________________ (Date Available) I am interested in: □Full time □Substitute AN EQUAL OPPORTUNITY EMPLOYER Applicant may submit a personal resume with this application to provide additional information regarding his/her qualifications for employment. EDUCATION (Cont’d) Transcripts of all completed college or university coursework should accompany this application. An official transcript (with university/college seal) will be required upon employment. Indicate any special training you have had. Name of University Date Degree Major Semester Hours Earned Quarter Hours Earned
OTHER WORK EXPERIENCE Name of Employer Complete Address: Street Number, City, Zip Beginning Mo/Da/Yr. Ending Mo/Day/Yr. Kind of Work Full Name of Reference Position/Responsibility Complete Address: Street, City, State, Zip Telephone
Parameter Name Description VolumeSerialNumber A 64-bit identifier that is unique to the volume. FileId A 128-bit identifier that is unique to the file or directory represented by the opened handle. Remarks: A 64-bit file identifier can be obtained from GetFileInformationByHandle in the nFileIndexHigh and nFileIndexLow members. This API is an extended version that includes 128-bit file identifiers. If GetFileInformationByHandle returns FILE_INVALID_FILE_ID, the identifier may only be described in 128 bit form. A 64-bit volume identifier can be obtained for NTFS volumes from FSCTL_GET_NTFS_VOLUME_DATA. A 32-bit volume identifier can be obtained on all Windows filesystems from GetVolumeInformation or GetVolumeInformationByHandleW. GetFileInformationByHandleEx FileIdExtdDirectoryInfo On a ReFS volume, will enumerate through a directory and include 128-bit file identifiers alongside other information for each entry in the directory. typedef struct _FILE_ID_EXTD_DIR_INFO { ULONG NextEntryOffset; FileIndex; LARGE_INTEGER CreationTime; LARGE_INTEGER LastAccessTime; LARGE_INTEGER LastWriteTime; LARGE_INTEGER ChangeTime; LARGE_INTEGER EndOfFile; LARGE_INTEGER AllocationSize; ULONG FileAttributes; ULONG FileNameLength; EaSize; UCHAR FileId[16]; ULONG ReparsePointTag; WCHAR FileName[1]; } FILE_ID_EXTD_DIR_INFO, *PFILE_ID_EXTD_DIR_INFO; Parameter Name Description
FileAttributes The attributes for the file or directory associated with this record, as returned by the function. Attributes of streams associated with the file or directory are excluded. FileNameLength The length of the name of the file or directory associated with this record, in The FileName member contains this name. Use this member to determine file name length, rather than depending on a trailing '\0' to delimit the file name in FileName. FileNameOffset The offset of the FileName member from the beginning of the structure. FileName The name of the file or directory associated with this record in Unicode format. This file or directory name is of variable length. When working with FileName, do not count on the file name that contains a trailing '\0' delimiter, but instead determine the length of the file name by using FileNameLength. Do not perform any compile-time pointer arithmetic FileName. Instead, make necessary calculations at run time by using the value of the FileNameOffset member. Doing so helps make your code compatible with any future versions of USN_RECORD. FSCTL_READ_USN_JOURNAL Retrieves the set of update sequence number (USN) change journal records between two specified USN values. This API has been extended to take an additional input structure that specifies the versions of USN records that the caller can accept. If this extended input buffer is not specified, the caller is
Role Name Dept/ College Email Address Mailing Address Number e.g. Dr. Jane Doe Note: PI cannot be a student Ed/ ESS jdoe@.wtamu.edu 2901 4th Ave. Canyon, TX 79016 O 555.555.5555 C 555.555.1111
Emergency Management Applicant Name Department of Military Affairs County Name Applicant Request for State Public Assistance Date Primary Contact Name, Title Mailing Address Phone Number E-Mail Address Type of Expense Damage Category Damages Documentation (Time cards, Invoices, Cancelled Checks, Equipment Journals, etc.) A B C Debris Clearance Protective Measures Roads & Bridges Labor Equipment Materials Contract Work Totals Applicants are encouraged to visit the WEM-WDF webpage to review the WDF Admin plan and the instructional “how to” video which explains how the “Toolkit” should be organized with supporting documentation. If an incorrect or incomplete document is submitted to WDF, it will be returned to the Applicant. Subsequently, the Applicant will be directed to the WEM-WDF webpage and will be encouraged to make contact with the WDF Coordinator to gain a better understanding of the program and how to submit a complete application package. WDF Coordinator: 608-242-3259 It is understood that the Applicant Documentation Toolkit and all supporting documentation will be submitted to the WDF Coordinator within 60 days of the disaster date. If an extension is needed, contact the WDF Coordinator. Typed Name of Chief Elected Official Signature of Elected Official Revised: December 2017
To be completed by Management RECEIVED INTERVIEWED REF CHECKS H / O APPLICATION FOR EMPLOYMENT 1882 GRILLE and The Barberry are equal opportunity employers, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability or national origin. Name (First, Last) Date Current Address Previous Address E-mail address Social Security Number Home Phone #: Mobile Phone #: Position(s) applying for: (Must check specific position listed to be considered) □ Floor Manager □ Sous Chef □ Kitchen Manager □ Wine/Bev Manager □ Server □ Bartender □ Host/Busser □ Server Assistant □ Line Cook □ Prep Cook □ Dishwasher □ Catering □ Administrative/Office (write-in)_____________________ □ Other (write-in) __________________________________ Did someone refer you to apply for this position? □ Yes □ No If yes, who? Are you 18 years of age or older? □ Yes □ No If you are applying for a server or bartender position, do you meet the legal state age requirement to serve alcohol? □ Yes □ No Do you have the legal right to work in the United States? □ Yes □ No It is the policy of this employer to hire only United States Citizens or individuals authorized to work in the United States. All employees must verify employment eligibility prior to beginning work.
Job Title / Position: Dates of Employment: ______________ / ________________ to Month/Year May we contact this employer? □ Yes □ No Explanation: Rate of Pay: Starting Wage $_____________ Ending Wage $____________
REQUEST FOR ACKNOWLDEGMENT OF RECEIPT OF MY NOTIFICATION OF 2 OR LESS GAMING MACHINES I, ………………………………………(insert name of the Licensing Act 2003 licence holder), request that this paper is returned to me at the following address and with the details below provided by the local licensing authority, so as to acknowledge my notification of 2 or less gaming machines at…………………………………………………………………………………..(insert name of premises). Insert address to which you wish this acknowledgement to be sent: …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………
Table X. Identity, function, origin, accession number, reference and location of the introduced genetic material for plasmid pMock808 Genetic element Function of the DNA region Source organism Gene Accession number Reference Right Border DNA region containing right border sequence used for transfer of the T-DNA Agrobacterium tumefaciens Depicker et al., 1982 Intervening sequence Sequence used in DNA cloning Escherichia coli nos 3’ Terminator and polyadenylation signal (see above). Agrobacterium tumefaciens Bevan et al. 1983, Depicker et al. 1982 cry1X1 Insect resistance gene. Bacillus thuringiensis MOCK123 (Adams 2001) Intervening sequence Sequence used in DNA cloning Escherichia coli e-35S Promoter with duplicated enhancer region Cauliflower mosaic virus (Kay et al. 1987; Odell et al. 1985) Intervening sequence Sequence used in DNA cloning Escherichia coli aad Antibiotic resistance marker gene containing its own regulatory sequences, ie promoter and termination sequences. Escherichia coli X04555 (Fling et al. 1985) Intervening sequence Sequence used in DNA cloning Escherichia coli nos 3’ Terminator and polyadenylation signal (see Agrobacterium tumefaciens As above. nptII Antibiotic resistance marker gene. Escherichia coli M61152 (Beck et al. 1982) e-35S Promoter (see above). Cauliflower mosaic virus As above. Intervening sequence Sequence used in DNA cloning Escherichia coli Left Border DNA region containing left border sequence used for transfer of the T-DNA Agrobacterium tumefaciens Depicker et al., 1982 Intervening sequence Sequence used in DNA cloning Escherichia coli ori-V Origin of replication for maintenance of plasmid in Agrobacterium Agrobacterium tumefaciens Stalker et al. 1981 Intervening sequence Sequence used in DNA cloning Escherichia coli ori-322 Origin of replication for maintenance of plasmid in E. coli Escherichia coli Sutcliffe 1979 Intervening sequence Sequence used in DNA cloning Escherichia coli
Course Name Course FCL Type Type of Training 1. Theory Flight Training/Simulation 2. Theory Flight Training/Simulation 3. Theory Flight Training/Simulation 4. Theory Flight Training/Simulation 5. Theory Flight Training/Simulation 6. Theory Flight Training/Simulation 7. Theory Flight Training/Simulation 8. Theory Flight Training/Simulation 9. Theory Flight Training/Simulation 10. Theory Flight Training/Simulation 11. Theory Flight Training/Simulation 12. Theory Flight Training/Simulation 13. Theory Flight Training/Simulation 14. Theory Flight Training/Simulation 15. Theory Flight Training/Simulation 16. Theory Flight Training/Simulation 18. Theory Flight Training/Simulation 19. Theory Flight Training/Simulation Insert additional lines if necessary Annex III: Flight Instructors (ref. 6.) List of flight instructors employed to provide the training courses offered Please enter the name of the instructor, the type of Licence, the Licence number and employment type.
Instructor Name Type of Licence Licence Number Employment 1. Full Time Part Time 2. Full Time Part Time 3. Full Time Part Time 4. Full Time Part Time 5. Full Time Part Time 6. Full Time Part Time 7. Full Time Part Time 8. Full Time Part Time 9. Full Time Part Time 10. Full Time Part Time 11. Full Time Part Time 12. Full Time Part Time 13. Full Time Part Time 14. Full Time Part Time 15. Full Time Part Time 16. Full Time Part Time 18. Full Time Part Time 19. Full Time Part Time Annex IV: Aerodrome(s) and/or operating site(s) to be used (ref. 7.) List of aerodromes used to provide training courses Please enter the full name and address of all aerodromes where training is taking place.
Supply of alcohol Standard days and timings (please read guidance note 7) Will the supply of alcohol be for consumption – please tick (please read guidance note 8) On the premises Off the premises Day Start Finis h Both Mon State any seasonal variations for the supply of alcohol (please read guidance note 5) Tue Wed Thur Non standard timings. Where you intend to use the premises for the supply of alcohol at different times to those listed in the column on the left, please list (please read guidance note 6) Fri Sat Sun
in details Date Time Venue name Venue address Key personnel involved in the promotion Name of licensed match-maker Name of licensed timekeeper Name of licensed practitioner Q1. Do you propose to provide any form of entertainment at the promotion (e.g. singing, dancing)? Please mark with an ‘x’ Yes No If yes, you must provide details: Q2. Please provide details (including the name of the insurer and the amount of cover) of public liability insurance that will be in place for the promotion. Q3. Does the venue listed above also have public liability insurance that will cover the event? Please mark with an ‘x’ Yes No Q4. Please provide costing details Matchmaking $ Accommodation $ Purses $ Other $ Advertising $ Proposed seating prices $ Venue hire $ Table $ Officials $ Seated $ Doctor $ Standing $ Airfares $ Other $ Q5. Please provide details of security arrangements Note: all security personnel must be licensed crowd controllers. Name of security firm Number of security personnel How will security personnel be identified? Q6. What steps will be taken to ensure the protection of officials from verbal and physical abuse and threats (e.g. it will be a condition of entry that persons behaving in an abusive or threatening way will be ejected from the venue)?
Subcontractors/ Franchisees, if any Name Address/Contact Details Activities Performed Resources Examiners /Others No. of Certification Schemes Operating Under this Franchisee Any Other Business Associates (Marketing or Any other Purpose) Name Address/Contact Details Activities Performed Resources Examiners/Others No. of Certification Schemes Operating Under this Associate Sr.No. Scope ( Certification Schemes /Modules/Qualification ) Date of Commencement Locations (Regional Offices/Testing Centers) persons certified
THE PETITION of … of , , , Articled Clerk, SHOWETH AS FOLLOWS: THAT … your petitioner is a Canadian citizen [or a permanent resident of ] of the full age of eighteen (18) years; THAT … has complied with the educational and training requirements and qualifications prescribed by or under the Legal Profession Act (the “Act”); THAT … has paid all fees to the Law Society of Prince Edward Island as prescribed by or under the Act; THAT … has made application to the Council of the Law Society of Prince Edward Island and the Council has accepted such application and your Petitioner has received notification of such acceptance; and THAT … desires to be admitted to practice as a barrister, solicitor and attorney before and of this Honourable and to have administered to him the oaths of office as such. YOUR PETITIONER therefore humbly prays that it may please your Lordship to call your Petitioner to the bar of this Honourable Court and there to administer to him the Oaths of Office. AND YOUR PETITIONER as in duty will ever pray etc. … at Charlottetown, Queens County, Province of Prince Edward Island, this … day of … , A.D. 20 … . ________________________ Petitioner IN SUPPORT of this Petition will be read the Affidavit of the Petitioner sworn the day of the date hereof and the exhibits thereto and the Certificate of the Secretary\Treasurer of the Law Society of Prince Edward Island dated this … day of … , A.D. 20 … , all filed herein. This is the Exhibit “ … ” referred to in the Application of … sworn before me this … day of … , 20 … A.D.
IN THE MATTER OF the Legal Profession Act, R.S.P.E.I. 1988, c. L-6.1 AND IN THE MATTER OF the Application of … for admission as a Barrister, Solicitor and Attorney of the Supreme of Prince Edward Island and Administration of the Oaths of Office. ORDER BEFORE: UPON READING the petition of … . ON the supporting affidavits and certificates filed therewith; IT IS ORDERED that upon the administration of the Oaths of Office attached hereto as Schedule “A”, … be admitted as a Barrister, Solicitor and Attorney of the Supreme Court of Prince Edward Island. DATED at … , in … County, the … day of …, 20 … . … , J. SCHEDULE “ … ” ATTORNEY’S OATH OF ALLEGIANCE I, … , do swear that I will be faithful and bear true allegiance to Her Majesty, Queen Elizabeth the Second, Her heirs and successors, according to law. So Help Me God. to before me in the on this … day of … , 20 …
Application for Appeal against Outcome of Review Please ensure that you have read and understood the Appeal against Outcome of Review before completing this form. Please ensure the form is duly completed and signed before you produce it at One Stop @ SAC to make payment. Personal Details Name Click the fields to enter text Matric No. Programme of Study NRIC/Passport No. Email Contact Phone Contact Details of Appealed Course Course Code Course Title Offering School Academic Year & Term Taken Course Instructor Outcome of Review of Results Course grade before review : Course grade after review : Please provide details of your consultation with your mentor/course coordinator/School on the outcome of review below. Appeals with no evidence of consultation will not be processed. (Max 600 Chars) State clearly and concisely your reason for this appeal.
How many tonnes of gelatine in total will be handled in the establishment per week on average? PART 9(11) – Collagen Full Details of Activities How many tonnes of collagen in total will be handled in the establishment per week on average? PART 9(12) – Cold Store Full details of activities and specific products handled How many tonnes of product will be handled in the establishment per week on average? PART 10 – APPLICATION I hereby apply, as food business operator of the establishment detailed in Part 1, for approval to use that establishment for the purposes of handling products of animal origin for which Regulation (EC) No. 853/2004 lays down requirements, as set out in the relevant Parts of this document. Signature of Food Business Operator Date Name in BLOCK LETTERS If you need any help or advice about how to complete this form, or about the products to which the Regulation relates, or the circumstances in which approval under the Regulation is required, please contact the officer named below. When you have completed this form and collected the other information required, please send it to: Food and Health Team Leeds City Council Millshaw Park Way Leeds LS11 0LS Contact Name: Duty Officer IMPORTANT Please notify any changes to the details you have given on this form, in writing to the Food Authority at the address shown. Telephone: 0113 378 5900 E-mail: food.safety@leeds.gov.uk
To be submitted for Commission approval prior to the implementation of a new academic associate degree program. In addition, please note: A related degree program is defined as related to the approved degree program(s) currently offered by each school listed below. School # School Name Type City State Degree Granting Main: Yes: Branch: No: Contact Person Phone Email Program Title (e.g. Business Administration) Type of Program (Check One) Length of Program (in Months) Full Credential & Abbreviation Proposed Start Date Related Unrelated Course Distribution (Must match the Outline of a Degree Program form) Standards Semester/ Quarter Credit Hour Requirements Credit Hours Externship Information (Externship as listed on the Outline of a Degree Program; may include multiple courses) Semester Credit Hours Quarter Credit Hours Technical/Occupational 30/45 Total Externship Clock Hours: General Education 15/22.5 Other 0/0 Total Externship Credit Hours: Total 60/90 I certify that the information herein and attached hereto is correct and that this degree program has not been described in the catalog, advertised or offered to students. Name Signature Date ELECTRONIC SUBMISSION FORMAT REQUIREMENTS: Electronic Submissions may not be transmitted to the Commission via e-mail. The school’s response must be prepared in accordance with ACCSC’s (e.g., prepared as one Portable Document Format (“PDF”) file that has been prepared using Adobe Acrobat software (version 8.0 or higher) and which has a .pdf extension as part of the file name). The school will receive an e-mail confirmation that the file has been received within 24 hours of the submission. ACCSC has issued the Blueprints for Success Series: . ACCSC encourages the school to review this module prior to submitting this application. More information is available under the at . REQUIRED SUPPORTING DOCUMENTATION:
I consent to AfN communicating with regulator(s) and enforcement agencies (such as the police) about my UKVRN registration as part of AfN’s duty to protect the public and promote high standards. I understand that it is my responsibility to obtain support and/or supervision by a statutorily regulated health professional in order to work with vulnerable clients in the following groups if I do not have the special knowledge for autonomous practice: Children, Disabled, Ill /or at high risk I understand that unless I pay the annual registration subscription my name will not appear on the public record of the UKVRN Register and I will be unable to continue using the professional title Registered Nutritionist (RNutr) or Registered Associate Nutritionist (ANutr). I consent to the AfN contacting any person to obtain further information about my application or to verify the information which I have provided, including the programme director or programme administrator or other authorised person from my university to confirm I hold the qualifications listed in this application; and agree that any person whom is contacted may provide the AfN with any information about me which they hold. I understand that the AfN may contact me during the application process to request information and/or to update me on the progress of the application I understand that I may be contacted by the AfN if a complaint is made against me as a registrant, relating to Fitness to Practice I confirm that I have provided complete and accurate information in this form and accompanying documents. Signed Date (DD/MM/YYYY) Page intentionally
Application for Employment Initials and surname of applicant Position applied for I am legally eligible to work in the UK (evidence of this will be requested during induction of successful candidates) Yes No Where did you see this posted advertised? If you have more than one employer, please provide details of all posts below and continue on a separate sheet if necessary. Dates from – to Name and address of employer Job title and brief description To whom are/were you directly responsible Current salary Part time or full time Other benefits / allowances Reasons for leaving / wishing to Notice period
Dates from – to Subject Date started teaching if applicable Subjects you can offer to teach Level We may contact your referees if you are shortlisted for the next selection stage, so that references could be available for the Recruiting Manager. If you have previously worked for a college, please provide details as we may contact the College Principal. If you would prefer us not to contact your references at this stage, please tick the relevant box beside each referee below. Please note: for all referees details are essential
Previous Employer Address _____________________ City/St/Zip __________________ Telephone ___________________ From To Pay Position Supervisor Reason for leaving Previous Employer Address _____________________ City/St/Zip __________________ Telephone ___________________ From To Pay Position Supervisor Reason for leaving Previous Employer Address _____________________ City/St/Zip __________________ Telephone ___________________ From To Pay Position Supervisor Reason for leaving Previous Employer Address _____________________ City/St/Zip __________________ Telephone ___________________ From To Pay Position Supervisor Reason for leaving Have you ever been terminated? ( ) Yes ( ) No If yes, please explain circumstances: Please explain any gaps in your employment history: EDUCATION School Name/Location Years completed Degree Study/Major Elementary High School College/University Graduate/Professional Other ______________________________________________________________________________ ______________________________________________________________________________
Family Name Name Middle Names Name Ramelan Mudji Rachmat Gender Male Female ) ) Marital status Married Date of Birth 01 ⁄01 ⁄1970 Month Day Year Nationality Indonesia Email address Muji@feb,unila.ac.id Home Institution University of Lampung Faculty of Economics and Business Department Manajemen Course/Major Place of Birth DKI. Jakarta English Proficiency TOEFL score:550 TOEIC score: Japanese Proficiency Qualification none Language Learning History: none Other Information Allergy: Sea Food / Shrimp Special Dietary Needs: No Pork and it derivatives (silakan diisi masing masing) Any other conditions/information/requirements: Halal food, if it is impossible to separate the meal please kindly notify us, which contain pork Mohon di email ke muji@feb.unila.ac.id
EMPLOYMENT HISTORY Start Date End Date: Name, Location & Business of Employer: Job Title: Reason for Leaving: REFERENCES Please provide the names, addresses and contact details for two referees. One should be related to your current or most recent employment and one should be able to vouch for your knowledge, skills and experience, as described in the Job Specification. References will not be taken up without prior agreement. REFEREE 1 tick to confirm current/last employer REFEREE 2 Name: Name: Job Title: Job Title: Company Name: Company Name: Address: Address: No.: No.: EDUCATIONAL QUALIFICATIONS (you may be asked to provide evidence) Dates Name of school, college and/or university Subjects studied and grades obtained From To PROFESSIONAL QUALIFICATIONS (you may be asked to provide evidence) Dates
Email * Relationship *Can the referee be contacted prior to interview? Yes No Referee 2 *Surname/Family name Name Job Title *Address *Post Code *Country Telephone Fax Email * Relationship * Can the referee be contacted prior to interview? Yes No If you have applied to us within the last 3 months, are you happy for us to use the references from your earlier application? Yes No MONITORING INFORMATION The Practice recognises and actively promotes the benefits of a diverse workforce and are committed to treating all employees with dignity and respect regardless of race, gender, disability, age, sexual orientation, religion or belief. We therefore welcome applications from all sections of the community. Date of Gender Male Female I do not wish to disclose this Race relations (Amendment) Act 2000 * I would describe my ethnic origin as: Asian or Asian British Bangladeshi Indian Pakistani Any other Asian background Mixed White & Asian White & Black African White & Black Caribbean Any other mixed background Other Ethnic Group Chinese Any other ethnic group I do not wish to disclose this
Mailing Address (Include Postal Code) Telephone: Work: Home: Email: APPLICATION INFORMATION Position applied for OR work preferred _____________________________ Are you seeking Regular Regular Would you be willing to work as a casual employee? Full-time Part-time Yes No Employment Employment Please indicate hours/days available if part-time or casual Minimum salary expected Date available EDUCATION AND TRAINING Name & Address Length of Course Field of Study Grade/Diploma/ Degree Completed High School/GED Commercial or Technical Training Undergraduate College/University Other Continuing Education Professional Qualifications/Memberships/Licenses if applicable: All applicants are encouraged to include volunteer or unpaid experience related to this position. SPECIALIZED SKILLS SECRETARIAL/CLERICAL Word Processing Spreadsheets Databases Medical Keyboarding Terminology wpm Dictaphone Data Entry Graphics Scientific Other Terminology specify Shorthand Speed Please specify computer packages you are familiar with below, and rate your proficiency as follows: 1) course only/no experience 2) some working knowledge 3) proficient 4) expert ex: WP 8(3) B TECHNICAL SKILLS C TRADES/MAINTENANCE SKILLS EMPLOYMENT RECORD List most recent employment first Start Date Employer Address Position Held
Application For Employment Post Applied for: PERSONAL DETAILS: (Please complete in block capitals and black ink) Previous Name: (if applicable) Tel Home: DfE No (if applicable) Tel Work: Email Address: Tel Mobile: National Insurance No. EDUCATION, TRAINING AND QUALIFICATIONS Name and address of School Attended From To Full or Part-time Qualification Gained Grade Award Date FURTHER/HIGHER Establishment name and course attended From To Full or Part-time Qualification Gained Grade Award Date DETAILS OF PRESENT OR MOST RECENT EMPLOYMENT PREVIOUS EMPLOYMENT OUTSIDE EDUCATION Employer: Post: Full/Part Time From dd/mm/yyyy To dd/mm/yyyy
Day of the Week Admission Charges by Summary Revenue Codes Month of Admission Total Charges Admission Source Days in Special Units i.e., ICU, CCU, etc. Admission Type Patient Age at Admission in Years Five year groupings except less than 5 years, which is reported as “under one” for children under one year of age and “one to four” for children one to four years of age; over 84 years is reported in “85 and over” category) Physician Specialty Code As adopted by the AMA Health Care Professional Classification i.e., Attending, Other Patient Gender Patient Race/Ethnicity County of Patient’s Residence Patient Reason for Visit Please select one (1) of the following hospital characteristics: Diagnosis Codes Procedure Codes Teaching Status of the Facility E-codes Trauma Level AHRQ Broad Level Diagnostic Categories Level of Perinatal Service AHRQ Detailed Diagnostic Categories Urban/Rural Status of Health Care Facility on MSA, Non-MSA County Status Patient Discharge Status Primary Expected Payer Classification i.e., Medicare, Medicaid, Insurance, HMO, Self-Pay, Indigent, TriCare, Worker’s Compensation and Other Bed Size Based on Licensed Beds 100 beds or less, 101 – 299 beds, 300 or more beds Part IV: Ambulatory Surgery, Imaging, and Other Services/Equipment Requiring a Certificate of Need Encounter-Level Data Day of the Week Admission Diagnosis Codes Month of Admission Procedure Codes
Senior management in large business organisation, government administration and defence, and qualified professionals Public service manager [section head or above], regional director, health/education/ police/fire services administrator Other administrator [school principal, faculty head/dean, library/museum/gallery director, research facility director] Defence Forces Commissioned Officer Professionals generally have degree or higher qualifications and experience in applying this knowledge to design, develop or operate complete system; identify, treat and advise on problems; and teach others Air/sear transport [aircraft/ship’s captain/officer/ pilot, flight officer, flying instructor, air traffic controller] Please note If the person is not currently in paid work but had a job or retired in the last 12 months, please use the person’s last occupation. If the person has not been in paid work in the last 12 months, please write ‘8’ in the box.
FINANCIAL DETAILS Dependants How many people rely on you for financial support? Fortnightly income How much do you receive after tax every two weeks (fortnightly)? Pay after tax $ Pension $ What financial support do you receive for your dependants – for example, from a former or current partner? $ Other income – for example, workers compensation, interest, Superannuation income, rent or board paid to you $ Total income $ Fortnightly expenses How much is your cost of living every two weeks (fortnightly)? Rent or board $ Mortgage repayments $ Credit card and other loan repayments $ Utilities – water, gas, electricity, telephone and data $ Food $ Travel and motor vehicle costs $ Other expenses – for example, health care, child care, insurance $ expenses $ Assets Assets are things that you own or partly own House and land – market value $ Car or other motor vehicle – market value $ Other assets – for example, money owed to you, shares, trust funds $ Total assets $ Bank account details Current bank or credit union balances (total for all accounts) $ Total balances $ Debts Amount owing on your mortgage $ Amount owing on other loans $ Credit $ Total amount owing $ limit $ Other debts – for example, amount owed to businesses or individuals. Tell us about each debt. Attach information about each debt. $ debts $ CERTIFICATION I acknowledge that: I am the person making this application the facts are true to the best of my knowledge, information and belief I am aware that it is an offence under section 136 of the Victorian Civil and Administrative Tribunal Act 1998 to provide false or misleading information relating to this application and I am aware that the maximum penalty is 6 months imprisonment or a fine of 60 penalty units. You can find out more about penalty units on the Department of Treasury and Finance website www.dtf.vic.gov.au. Enter your name to acknowledge the statements above: Date: [dd/mm/yyyy]
Part 3. Total Household Gross income (before deductions). List all income on the same line as the person who receives it. Check the box for how often it is received. Record each income only once. 1. Name (list only household members with income) 2. income and how often it was received Earnings from work before deductions. Weekly Every 2 Weeks Twice Monthly Monthly Welfare, child support, alimony Weekly Every 2 Weeks Twice Monthly Monthly Social Security, SSI, VA, retirement benefits Weekly Every 2 Weeks Twice Monthly Monthly All other income (such as Unemployment) benefits Weekly 2 Weeks Twice Monthly Monthly (Example) Jane $200 X $150 X $0 $0 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
APPLICATION FOR ‘HAPPY SMILES’ In Swindon Schools If you would like to apply for the Happy Smiles programme, please complete the application form, and send it to us at the following address: Name and address of school: Contact name: Email address: Telephone number: Numbers of pupils in foundation years: Numbers of pupils in KS1: Numbers of pupils in KS2: Numbers of pupils in resource classes:
Section 8. Additional Information Has your child had any contact with any of the services or agencies below? Please tick and provide contact details where appropriate. Behaviour Support Contact name: Tel: Child And Adolescent Mental Health Service (CAMHS) Contact name: Tel: Counselling Contact name: Tel: Drugs Action Team Contact name: Tel: Educational Psychology Contact name: Tel: Education Welfare Contact name: Tel: Learning Support Contact name: Tel: Pediatrician Contact name: Tel: Speech And Language Contact name: Tel: Social And Communication Contact name: Tel: Social Care Contact name: Tel: Youth Early Support Panel Contact name: Tel: Other: Contact name: Tel: Section 9. Fraudulent claim
Why do you want your child to move to a new school? Please give as much information as you can to support your request (please attach an additional sheet if required). Have you withdrawn your child from school? Yes No If yes, please tick the box most relevant to you. If other please specify below: At risk of being excluded Elective home education House move Withdrawal by parent If please specify in the box below, please give as much information as you can: Is your child out of school because he/she has been permanently excluded? Yes No If yes, which school? Date of exclusion: Local authority in which school is based: Reason(s) for exclusion: Section 6. Application for child newly arrived from overseas Date of arrival: Country arrived from: Previous School: first language: Subjects taught: Other languages spoken by the child: Has your ever attended schools in the UK? Yes No Previously attended school(s): School Name and Telephone Number School Address Leaving date Reason for Leaving
Section 8. Additional Information Has your had any contact with any of the services or agencies below? Please tick and provide contact details where appropriate. Behaviour Support Contact name: Tel: Child And Adolescent Mental Health Service (CAMHS) Contact name: Tel: Counselling Contact name: Tel: Drugs Action Team Contact name: Tel: Educational Psychology Contact name: Tel: Education Welfare Contact name: Tel: Learning Support Contact name: Tel: Pediatrician Contact name: Tel: Speech And Language Contact name: Tel: Social And Communication Contact name: Tel: Social Care Contact name: Tel: Youth Early Support Panel Contact name: Tel: Other: Contact name: Tel: Section 9. Fraudulent claim
4. School officials fully accept and support the concept of accreditation as a voluntary, process involving peer review and a necessary degree of confidentiality in and record keeping. 5. School officials understand that, in applying for accreditation, the school: a. Voluntarily accepts responsibility to comply with the Standards of Accreditation. b. The school voluntarily submits itself to a periodic review and a reasoned judgment by the Commission as to the school’s qualifications in accordance with the Commission’s Rules of Process and Procedures and voluntarily accepts responsibility to comply with the Standards of Accreditation and the ACCSC Bylaws; c. The school accepts the responsibility to demonstrate that the school is meeting the standards and must supply the Commission with complete documentation of the school’s compliance with all accrediting standards and requirements in order to be granted and to maintain accreditation; d. Has every opportunity, as part of the accrediting process, to present itself in its best light and to respond to any concerns; e. Assumes an obligation to be forthcoming, complete, and accurate in presenting information to, and answering questions of, the Commission; f. Can exercise the to appeal a fail to grant decision of the Commission, thereby assuring an independent review; and g. It is the responsibility of the school to ensure that all submissions to the Commission are complete and represent the school’s efforts to demonstrate compliance with accrediting standards and requirements; h. ACCSC staff and volunteers are not required to advise a school as to whether any materials submitted to the Commission are complete or demonstrate compliance with accrediting standards or requirements; i ACCSC staff and volunteers may provide advice and feedback to a school regarding compliance matters, but any representations made by ACCSC staff or volunteers do not restrict the Commission’s ability reach its own conclusions or to take any action the Commission deems appropriate; and j. The Commission is the ultimate decision-making body and makes final determinations about a school’s compliance with accrediting standards and requirements, and a school’s accredited status and the Commission takes actions and makes decisions as deemed most appropriate by the Commission based on the written record. 6. A non-member school will not make any promotional use of its application for accreditation prior to a grant of accreditation. DISCLOSURES: Yes No
Part 2 - Lists undertakers who need only be consulted if an assessment of a specific site identifies they may be affected COLT Telecomms (City of London Telecomms Ltd) Undertaker Code: CS31 Address Telephone Fax Contact Name Email Address Website Comments Colt Protection Centre, c/o McNicholas Construction (Colt Managing Agents), 117 Bushey Mill Lane, Walford, Herts, WD24 7UN 020 82366612 020 82366600 John Richardson Currently in South of city only *Royal Mail Undertaker Code: SW01 Address Telephone Comments Leeds Mail Centre, Leodis House, Leodis Way, Stourton, Leeds, LS10 1AZ 0113 3866658 Royal Mail post pouches and boxes. Consult only where apparatus is evident ES Pipelines Address Hazledon, Station Road, Leatherhead, Surrey, KT22 7AA Telephone 01372 227560 Undertaker Code: ZY001 Comments Formerly British Gas Connections *FibreSpan Ltd* Undertaker Code: XM01 Address The Quay, Channel Way, Ocean Village, Southampton, SO14 3QG
Appendix 5 Checklist of Information to be supplied by Applicants □ Completed Application Form □ Licence fee □ Two copies of apparatus location plan (min 1:1250) □ TM plan □ Bond fee if applicable □ Copy of public liability insurance certificate □ Copy of supervisor and operative NRSWA accreditation cards (both sides) must cover the type of surfaces being reinstated. □ Copy of method statement □ Advance notice form Checklist of information to be supplied once works have commenced □ Notice of actual start form □ Reinstatement form Appendix 6 Notice of Actual Start Form To: Highways & Transportation Network Support Team Leeds City Council 3rd Floor St George House 40 Great George Street LS1 3DL Contact: Network Support Team Tel: 0113 3787007 Fax: 0113 2477018 Email: raswa.forms@leeds.gov.uk Your reference: From: (Insert your address)
[snowmobile(s), trailer(s), boat(s), etc.] □ Yes □ No If Yes, please specify the type of vehicle: ___________________________________ Pet Control Do you have any pets? □ Yes □ No If Yes, please specify: _________________________________
Fenestration Self-Assessment Scheme Wall Insulation Guarantee Agency (SWIGA) The Contractor’s Health and Safety Assessment Scheme (CHAS) Cavity Wall Insulation Self Certification Scheme NICEIC Renewable Energy Consumer Code (RECC) Other (Please list all relevant schemes and corresponding membership numbers) Please tick all that apply and provide relevant membership number. Royal Institution of Chartered Surveyors Royal Institute of British Architects Building and Engineering Services Association (formally HVCA) National Insulation Association Electrical Contractors Association Energy Institute Other (Please list all relevant bodies and corresponding membership numbers) Yes No Please note: The GD ORB will conduct a credit as part of the verification process. If yes, please provide the following information:
Application for NURSERY Admission St. Edward’s C.E Academy Cheddleton DETAILS NURSERY SESSIONS REQUIRED Monday 8.45am-3.00pm Tuesday 8.45am-3.00pm Wednesday 8.45am-11.30am OR 12.30pm-3.00pm Thursday 8.45am-3.00pm Friday 8.45am-3.00pm I would prefer the BEGINNING of the week I prefer the END of the week I require a place x5 days each week I prefer these sessions (we will try to accommodate requests via our wrap-around care) am am am am am pm pm pm pm pm I require childcare for Breakfast club 7.30am-8.45am Additional cost Monday Tuesday Wednesday Thursday Friday Afterschool club 3.00pm-6.00pm Additional cost Are you eligible for 30 hour funding? (Up to 10 hrs a day free childcare for working parents) FURTHER INFORMATION ABOUT YOUR CHILD ABOUT THE PERSON COMPLETEING THIS FORM Please complete this form for admission to St. Edward’s Academy Cheddleton Nursery Setting and return to the school office by email or by post- Nursery Admissions, St. Edward’s Academy Cheddleton, Hollow Lane, Cheddleton, Staffordshire, ST13 7HP FOR FURTHER INFORMATION ON NURSERY ADMISSIONS SEE OUR WEBSITE or call the office on 01538 714840
Application for Participation in Shoes for Crews Instructions Please submit a completed application to for each new department or unit that is requesting participation in the Shoes for Crews program. Name Phone #/e-mail Department ____________________________________________________________ Please list the job titles of the employees you wish to enroll: Please list the specific job duties the above employees perform that present a slip and fall hazard : Briefly describe the slip and fall hazard(s): Please submit this completed application to . Questions? Contact EHS staff at 415.338.2565.
This is only a Scholarship Application for the Non-Traditional Deaf Education Certification Program thru Region 17 ESC This application does not assure entry into Texas Tech University Applications accepted January 7 - March 8, 2019 Social Security # EDUCATION SERVICE CENTER Last Name First Name Middle Name Mailing Address Street City State Zip Permanent Home Address Street City State Zip Email Cell phone No. Valid Texas Teacher Certificate: Yes No or more years teaching experience: Yes No Years Taught University or Colleges Attended: Non-Traditional Deaf Education Certification Program for Teachers Types of Teaching Certificate: Closest Education Service Center School District Grade levels taught: Sign Language Skills: None Beginning Intermediate Advanced Submit the following to: Region 17 ESC – Deaf Education Certification Program 1111 West Loop 289 • Lubbock, TX 79416:  Completed application form (this brochure)  $50.00 application fee made out to: Region 17 ESC  Application - 1 page maximum Why I Would Be A Good Candidate For This Program  One letter of recommendation from school administrator  One letter of recommendation from teaching colleague  Copy of teaching certificate TEA Deaf Services
Are you in good health at the moment? Have you had a condition affecting your skin in the last two years? Are you currently receiving any treatment, medication, have any active implanted or body worn medical devices e.g. insulin pump, pacemaker or receiving specialist support? Do you require any workplace adjustments or support to enable you to undertake the post? Have you ever been diagnosed with Tuberculosis or Do you have symptoms which may be due to Tuberculosis e.g. an unexplained persistent productive cough, shortness of breath, fatigue, weight loss or night sweats? Have you been in contact with an individual with active open Tuberculosis or returned from a country where Tuberculosis incidence is > 40 per 100,000 per year? Please use the space below to provide further information on your answers: The Occupational Health Service may contact you via e-communications. Please tick if you DO NOT wish to receive e-communications from Occupational Health e.g. text appointment reminders, to annual patient satisfaction questionnaire Your details will not be shared with any third party