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1. Complete ALL items in SECTION I and II ONLY. PRINT IN PEN OR TYPE ALL INFORMATION* 2. Include copies of all course completion certificates. 3. BE SURE TO SIGN AND DATE YOUR APPLICATION* FAILURE TO COMPLETE THIS APPLICATION FULLY WILL CAUSE IT TO BE REJECTED AND RETURNED AS INCOMPLETE* I. Applicant Information Phone No* Work Home Email Address Employer Name Employer Address PLEASE ENTER ANY ADDRESS CORRECTIONS IN THE SPACE BELOW County of Employment II. Renewal Training Credits Summarize b ...

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