Authorizing Signature Sample Clauses

Authorizing Signature. Date: RECYCLED PARTS QUALITY ASSURANCE I agree to maintain the highest standards of Recycled Parts Quality Assurance by implementing and managing systems in the following key areas:
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Authorizing Signature. This authorization is to remain in full force and effect until LABBB and BANK have received written notice from me of its termination in such time and in such manner as to afford LABBB and BANK a reasonable opportunity to act on it. Employee Signature: Date For A123456789A 0123456789 0100 ( A voided check or bank letter with your routing number and account number is required. ) Routing/Transit # (a 9-digit # always between these two marks) Checking Account # Check # (matches # in upper right hand of the check is not needed here)
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Authorizing Signature. Section Referee Administrator Signature for National or Area Referee Administrator Signature for Intermediate and Advanced Required USSF Authorizing Signature: State Referee Administrator Signature Return form and fees to: United States Soccer Federation Referee Department – AYSO Form 0000 X. Xxxxxxx Xxxxxx Xxxxxxx, XX 00000 Return form to: AYSO National Office Programs Department 00000 X. Xxxxxxx Xxx., Xxxxx 000 Xxxxxxxx, XX 00000 Last name First Name M I Address Social Security # City State Zip Phone ( ) email AYSO Referees: Section/Area/Region / /_ USSF Referees: State Association ATTENTION USSF REFEREES: Cross-certification to an AYSO Referee also requires completion of the AYSO Safe Haven Certification Course. Additionally, all AYSO referees must be approved by and registered with a local AYSO Region and must annually complete a Volunteer Application Form. Please contact your local AYSO Regional Commissioner to submit a Volunteer Application Form and arrange for completion of AYSO Referee Safe Haven certification. Once approved by the R egion, please have the Regional Commissioner sign below. I verify that the above named person is an approved volunteer in Region # . Regional Commissioner Signature My certification level with (AYSO or USSF) is . I am currently a certified referee of either AYSO or USSF, but not both. I have been a referee in _(AYSO or USSF) since (date of first certification). I am requesting cross-certification from AYSO to USSF or from USSF to AYSO as a(n) referee.
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Authorizing Signature. Signature: Date: (Please do not print; your signature is required) (MM/DD/YYYY) DISCLOSURE REGARDING YOUR BACKGROUND INVESTIGATION US1 LOGISTICS, LLC or its affiliate companies (“the Company”) may obtain information about you for employment purposes through its contracted Third-party Verifier, WorkforceQA. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” procured by a Consumer Reporting Agency (CRA). The report is an independent investigation of your background, which pursuant to Section 603 of the Fair Credit Reporting Act (FCRA) may include information regarding your character, general reputation, personal characteristics, or mode of living. The scope of the report may include information concerning your driving record, civil and criminal court records, education, credentials, identity, past addresses, Social Security Number, substance abuse testing results, Worker’s Compensation information, previous employment, and personal references. If you are denied employment as a result of information obtained from your background check, pursuant to the FCRA, the Company will furnish you with the required adverse communications, which include a copy of your background report, a copy of A Summary of Your Rights Under the Fair Credit Reporting Act, and instructions on how to dispute inaccurate information contained within the report. US1 LOGISTICS, LLC or its affiliate companies will procure the report from: CRA: ASURINT, Compliance Department ● P.O. Box 14730 ● Cleveland, OH 44145 ● (000) 000-0000 ● xx.xxxxxxx.xxx/Xxxxxxxxxx.xxxx US 1 LOGISTICS, LLC XXXXXX’s STATEMENT OF ON-DUTY HOURS (For Newly Hired Drivers)
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Authorizing Signature. Pastor/Director The undersigned is authorized to sign as a legal representative on behalf of the church/organization. The undersigned authorizes that the church/organization has received and reviewed the Ministry Agreement and understands the commitments of the Ministry Agreement. The undersigned further certifies that all statements regarding the church/organization are true and complete. Signature: Date: Name: Email: Title:
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Authorizing Signature. This authorization is to remain in full force and effect until LABBB and BANK have received written notice from me of its termination in such time and in such manner as to afford LABBB and BANK a reasonable opportunity to act on it. Employee Signature: Date For A123456789A 0123456789 0100 ( A voided check or bank letter with your routing number and account number is required. ) Routing/Transit # (a 9-digit # always between these two marks) Checking Account # Check # (matches # in upper right hand of the check is not needed here) xxx.xxxxx.xxx • 00 Xxxxxxxxx Xxxxxxxx, Xxxxxxx, Xxxxxxxxxxxxx 00000 • (000) 000-0000
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Authorizing Signature. Section Referee Administrator Signature for National or Area Referee Administrator Signature for Intermediate and Advanced Required USSF Authorizing Signature: State Referee Administrator Signature Return form to: Xxx XxXxxxxxxxx - AYSO Section 8 Referee Administrator: xxxxxxxxxxxxxx@xxxxx.xxx Xxxxxx Xxxxxx - Michigan USSF State Referee Administrator: xxx@xxxxxxxxxxxx.xxx Return form to: Xxx XxXxxxxxxxx - AYSO Section 8 Referee Administrator: xxxxxxxxxxxxxx@xxxxx.xxx Xxxxxx Xxxxxx - Michigan USSF State Referee Administrator: xxx@xxxxxxxxxxxx.xxx Last name First Name M I Address Social Security # City State Zip Phone ( ) email AYSO Referees: Section/Area/Region / /_ USSF Referees: State Association ATTENTION USSF REFEREES: Cross-certification to an AYSO Referee also requires completion of the AYSO Safe Haven Certification Course. Additionally, all AYSO referees must be approved by and registered with a local AYSO Region and must annually complete a Volunteer Application Form. Please contact your local AYSO Regional Commissioner to submit a Volunteer Application Form and arrange for completion of AYSO Safe Haven certification. Once approved by the R egion, please have the Regional Commissioner sign below. I verify that the above named person is an approved volunteer in Region # . Regional Commissioner Signature My certification level with (AYSO or USSF) is . I am currently a certified referee of either AYSO or USSF, but not both. I have been a referee in _(AYSO or USSF) since (date of first certification). I am requesting cross-certification from AYSO to USSF or from USSF to AYSO as a(n) referee.
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Related to Authorizing Signature

  • AUTHORIZING SIGNATURES The following authorizing signatures are attached: U.S. DEPARTMENT OF THE INTERIOR A. Bureau of Land Management B. U.S. Fish and Wildlife Service C. U.S. Geological Survey

  • AUTHORIZING SIGNATURES (cont I. Office of the Assistant Secretary of Defense (Energy, Installations, and Environment) DALSIMER.ALLYN. Digitally signed by XXXXXXXX.XXXXX.XXX.1284843602 DN: c=US, o=U.S. Government, ou=DoD, XXX.1284843602 ou=PKI, ou=OTHER, cn=DALSIMER.XXXXX.XXX.1284843602 Date: 2016.08.11 11:15:51 -04'00' Xxxxxx X. Xxxxxxxx Date Director, DoD Natural Resources Program 8‐26‐16

  • Counterpart Signature This Agreement may be signed in counterpart, and the signed copies will, when attached, constitute an original Agreement.

  • Signature Signature For the participant For the institution Xxxxxx Xxxxx prof. Ing. arch. Xxxxxx Xxxxxxx, PhD. Vice-xxxxxx for International Relations and Public Relations, based on the procuration Annex I

  • Counterpart Signatures For the purpose of facilitating the recordation of this Agreement as herein provided and for other purposes, this Agreement may be executed simultaneously in any number of counterparts, each of which counterparts shall be deemed to be an original, and such counterparts shall constitute but one and the same instrument.

  • Contract Signature If the Original Form of Contract is not returned to the Contract Officer (as identified in Section 4) duly completed, signed and dated on behalf of the Supplier within 30 days of the date of signature on behalf of DFID, DFID will be entitled, at its sole discretion, to declare this Contract void. No payment will be made to the Supplier under this Contract until a copy of the Form of Contract, signed on behalf of the Supplier, is returned to the Contract Officer.

  • AGREEMENT SIGNATURES By signing below, both parties agree to the terms and conditions of this Agreement. Please acknowledge acceptance of this document and terms by returning a signed copy within seven (7) days of issuing. If a signed copy is not returned within seven (7) days and you are attending service, Fighting Chance will deem this to be acceptance of the document. If signed by Xxx XxxXxxxxxxX: Signature of Participant: Date: If signed by Person Responsible: I confirm that this Agreement has been explained to the individual receiving the services and that they agree to the terms. I further confirm that I have authority to sign on their behalf. Signature of Person Responsible: Date: SignaĒure on behalf of FighĒing Chance: Signature of Person(s) responsible: Date: Name: Appendix 1 Key Contact Details Participant’s Name Participant’s Email Participant’s Phone Participant’s Address Person(s) responsible’s Name Person(s) responsible Relationship to Participant Person(s) responsible’s Email Person(s) responsible’s Phone Support Coordinator (where applicable) Support Coordinator’s Name Support Coordinator’s Email Support Coordinator’s Phone Shared Living/Supported Accommodation/Group Home (if applicable) House Manager’s Name House Manager’s Email House Manager’s Phone Additional Contacts (if applicable) Role Contact’s Name Contact’s Email Contact’s Phone Appendix 2 NDIS Claiming Preferences Fighting Chance supports NDIS participants who are NDIA-Managed, Self-Managed or Plan Managed. To invoice and bill you correctly, it is important you keep us updated with your plan management preferences, and let us know ongoing if your status changes. For the purposes of services delivered by Fighting Chance, your NDIS plan is: (please tick) ☐ NDIA-MANAGED You understand that Fighting Chance will claim directly through the NDIA portal if your funding for Fighting Chance is NDIA-managed, so you will not receive any direct request for payment from us. To ensure that you do not get a text from the NDIA to approve each claim weekly, endorse Fighting Chance as a ‘My Provider’ for automatic payment processing. Instructions can be found at xxxxxxxxxxxxx.xxx.xx/xxxx/ or you can contact the Fighting Chance My Provider Endorsement Helpdesk on (00) 0000 0000 or xxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx.xx ☐ (Optional) Please supply me, by email, with monthly Statements of Account to: ☐ SELF-MANAGED ☐ I am self-managed and would like to be invoiced for services once a week. Please email invoices to: Please see Appendix 3 for Self-Management Payment Options. ☐ PLAN-MANAGED Please send invoices to my plan manager: Plan management organisatio Contact Name Email Address Phone number ☐ OTHER FUNDING (eg. self-funded, iCare or other insurance funding) Please email invoices to: Appendix 3 Self-Managed Payment Options Participants who are self-managed have a number of payment options with Fighting Chance: ☐ DIRECT DEPOSIT (preferred option) Payment of Fighting Chance invoices can be made by Electronic Funds Transfer (EFT) through your bank. Fighting Chance’s bank account details are as follows: Bank: Commonwealth Bank of Australia Account Name: Fighting Chance Australia Ltd BSB: 062-438 Account Number: 00000000 To ensure all payments are correctly allocated to your account, please include the full invoice number in the reference field. ☐ CREDIT CARD Payments can be made by credit card by clicking the ‘pay by credit card’ link included on the invoice. Please note that a service fee for this option will be imposed. ☐ PAYPAL Payment of your invoices can also be made via our PayPal account. To make payment via PayPal, please access the following link: xxxxx://xxxxxx.xx/FightingChanceAus?locale.x=en_AU To ensure your payment is correctly allocated, please enter the full invoice number in the reference field. Appendix 4 Non Face to Face Time Breakdown - Jigsaw Standard Non Face-to-Face Supports Delivered to every Jigsaw Participant daily, weekly, annually Writing the Board (i.e. preparing and writing up each person’s individualised program for the following day). Reviewing Trainee records/journal notes/medical or other key information to be able to best support the person during their day. Parent/Guardian/Carer Updates, i.e. emails, phone calls. Pre- and post-shift sta briefings. Zone setup (setting up workstations, boxes, visuals and group training areas) Resource development to support each Trainee to progress towards their employment goals (adapting training resources, creating visual aids and cheat sheets, etc). Research/Coordination to implement support strategies (disability, behavioural and learning strategies). Family reviews and the development of training plans (planning, delivery and follow up). Planning social events and extra curricular training (e.g. TAFE). Standard NDIS Annual Support Review Letter. Standard Ǫuarterly Reports - Upon Request. Complex Non Face-to-Face Supports - Delivered to Jigsaw Participants with High Intensity Support Needs (in addition to supports outlined in Standard) Allied health meetings, phone calls, correspondence. Specialist/additional sta training (internal or external), i.e. BSP implementation training. Creation of additional/detailed social stories/visuals. Data collection requested by behaviour therapists. Incident follow up or crisis meetings (seperate to regular family updates or regular allied health meetings). Development/review/discussion of medication forms/transfer plans/mealtime assistance plans etc. Detailed and regular sta training on individual complex behaviour/medical/transfer/mealtime support plans. Extended daily pre-brief and debrief. Additional Non Face-to-Face Supports - billed separately upon request Detailed NDIS Review Letters One-o engagement or training with Allied Health. Detailed Ǫuarterly Reports.

  • Preparer’s Signature The person completing the DBE commitment form on behalf of the consultant’s firm must sign their name.

  • Signature This Section 2 and the exercise form attached hereto set forth the totality of the procedures required of the Holder in order to exercise this Purchase Warrant. Without limiting the preceding sentences, no ink-original exercise form shall be required, nor shall any medallion guarantee (or other type of guarantee or notarization) of any exercise form be required in order to exercise this Purchase Warrant. No additional legal opinion, other information or instructions shall be required of the Holder to exercise this Purchase Warrant. The Company shall honor exercises of this Purchase Warrant and shall deliver Shares underlying this Purchase Warrant in accordance with the terms, conditions and time periods set forth herein.

  • Counterparts and Signatures The Agreement may be executed in multiple counterparts, each of which shall be deemed an original, but all of which taken together shall constitute one and the same instrument. A Party may evidence its execution and delivery of the Agreement by transmission of a signed copy of the Agreement via facsimile or email. In such event, the Party shall promptly provide the original signature page(s) to the other Party.

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