TO BE COMPLETED BY THE APPLICANT. I understand that:
TO BE COMPLETED BY THE APPLICANT. I Mr./Mrs./Miss ………………………………………………………………MNO…………………...
I. D/Passport No. (Attach Copy) Hereby apply for a loan of Kshs ………………..………………………………………………………… Amount in words ………………………………………………………………………………………. To be repaid in Months (Maximum 24 Months) I authorize my employer to recover the loan granted to me from my monthly salary in installments which may be determined by management committee plus interest at the rate of 1.125% on the reducing balance. I hereby attach my most current stamped pay slip and a copy of ID Signature (Applicant)……………………………………………. Date………………............................
TO BE COMPLETED BY THE APPLICANT. I Mr./Mrs./Miss ………………………………………………………………MNO…………………...
I. D/Passport No. (Attach Copy) Hereby apply for a loan of Kshs ………………..………………………………………………………… Amount in words ………………………………………………………………………………………. To be repaid in… Months (Maximum 24 Months) I authorize my employer to recover the loan granted to me from my monthly salary in installments which may be determined by management committee plus interest at the rate of 1.125% on the reducing balance. I hereby attach my most current stamped pay slip and a copy of my National Identity Card. For individual member (not in employment), please provide 3 months certified bank statements (management may request for additional information). Signature (Applicant)……………………………………………. Date………………............................
TO BE COMPLETED BY THE APPLICANT. I was granted a license as described above and request that verification of that license and supervised experience approved by your board, as applicable, be submitted to the Texas State Board of Social Worker Examiners. You are hereby authorized to release any information in your files, favorable or otherwise, directly to this state's Social Work Board. Your early attention is appreciated. Signature Date PART II-TO BE COMPLETED BY THE STATE BOARD VERIFYING LICENSURE (Please complete this form and return it to the address indicated. Attach copies of any verification of supervision received after applicant received their MSW.) Name of Licensee Licensure Level License No. Date Issued Please Verify All Requirements Met in Your Jurisdiction *Explain Complaints or Disciplinary Actions (please enclose a copy of any board orders): With few exceptions, you have a right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. Most information submitted to the board is subject to disclosure under the Public Information Act. (Reference: Government Code, Sections 522.021, 522.023, 559.003 and 559.004) Revised 10/13/07 FORM III TEXAS STATE BOARD OF SOCIAL WORKER EXAMINERS
TO BE COMPLETED BY THE APPLICANT. Full Name ……………………………………………..…..….…….I.D/Passport No… (Attach Copy) KRA Pin ………………….…………….(Attach Copy) Membership Number…………. Payroll Number………….. Age……… Physical Address (Home/Estate/Street/House Number) ………………..………………………………………. P.O. Box ………..…..… Code …………… E-mail …………………………………. Telephone (Private)…..……...… Amount in figure:……………………Amount in words ………………………………………………… …… Repayment period (Maximum 36 Months). I have identified the item (s) at shop.
TO BE COMPLETED BY THE APPLICANT. I understand that it is my duty (within the boundaries of my role), to safeguard the children, young people and vulnerable adults with whom I have contact. I know what action to take in cases of suspected or alleged abuse or if I am concerned.
TO BE COMPLETED BY THE APPLICANT. Please use a separate application for each course applied for. At (School). The regular instructional day is from AM to PM. (Schools with Extended Hours do not qualify for variances under Article D.22.1.d) (Please attach a copy of the regular student timetable, showing times of period changes.) I, (Please Print Name) would like to apply for a variance in order to teach (course) from AM/PM to AM/PM on Please complete and submit a rationale statement that addresses the criteria for approval of Variance applications. In signing this form I agree that the STA may vary the length of my instructional day. This agreement is given of my own free will and voluntarily. I was not asked to agree to this schedule as a condition of employment. (Signed) on , 2023
TO BE COMPLETED BY THE APPLICANT. I agree to abide by the Church’s policies for safeguarding children, young people and vulnerable adults. I understand that it is my duty to safeguard the children and young people and vulnerable adults with whom I have contact. I know what action to take in cases of suspected or alleged abuse and agree to adhere to the Archdiocese of Liverpool code of conduct.
