For Department Use Only Sample Clauses

For Department Use Only. After investigating this request, it is respectfully recommended the application be: Financial Management Office Date Coordinator’s Immediate Supervisor Date Sector Commander or Designee (location of event) Date Chief of Police or Designee Date PAID $ Check # EXEMPT Approved NOT Approved Approved NOT Approved Approved NOT Approved Cash Date applicant notified of approval/ disapproval: By:
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For Department Use Only. Signature of Department Official Approving the Transfer Date Approved Printed Name Title CERTIFICATE OF OWNER’S AUTHORIZATION FOR TRANSFER Mail to: Coastal Construction Control Line Program Office of Resilience and Coastal Protection Department of Environmental Protection 0000 Xxxxx Xxxxx Road, Mail Station 3522 Tallahassee, Florida 32399-2400 Permit Number: Permittee Name: Permit Agent: If the applicant is not the owner of record, the applicant shall complete this certificate by which the owner authorizes the applicant to act as the owner’s agent for the purpose of applying for a permit transfer and to act on behalf of the owner in other matters pertaining to the permit. I hereby authorize the above named permit agent to make application for a permit transfer on the above- named property (permit) and to act in my behalf in other matters pertaining to the permit. Signature of Property Owner Date Printed or Typed Name of Property Owner
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For Department Use Only. Signature of Department Official Approving the Transfer Date Approved Printed Name Title CERTIFICATE OF OWNER’S AUTHORIZATION FOR TRANSFER Mail to: Coastal Construction Control Line Program Division of Water Resource Management Department of Environmental Protection 0000 Xxxxx Xxxxx Road, Mail Station 3522 Xxxxxxxxxxx, Xxxxxxx 00000-0000 Permit Number: Permittee Name: Permit Agent: If the applicant is not the owner of record, the applicant shall complete this certificate by which the owner authorizes the applicant to act as the owner’s agent for the purpose of applying for a permit transfer and to act on behalf of the owner in other matters pertaining to the permit. I hereby authorize the above named permit agent to make application for a permit transfer on the above- named property (permit) and to act in my behalf in other matters pertaining to the permit. Signature of Property Owner Date Printed or Typed Name of Property Owner
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For Department Use Only. After investigating this request, it is respectfully recommended the application be: Coordinator’s Immediate Supervisor Date Sector Commander or Designee (location of event) Date Chief of Police or Designee Date Approved NOT Approved Approved NOT Approved Approved NOT Approved Date applicant notified of approval/ disapproval: By:
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For Department Use Only. Recommended for approval: (Area Land Use Engineer) Date Recommended for approval: (Regional Traffic Engineer) Date Recommended for approval: (District Engineer/Administrator) Date
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Related to For Department Use Only

  • Department of Health and Human Services An employee notified of a positive controlled substance or alcohol test result may request an independent test of their split sample at the employee’s expense. If the test result is negative, the Employer will reimburse the employee for the cost of the split sample test. An employee who has a positive alcohol test and/or a positive controlled substance test may be subject to disciplinary action, up to and including dismissal, based on the incident that prompted the testing, including a violation of the drug and alcohol free work place rules.

  • Social Services For Applicants residing in a state NB is licensed, NB will conduct the home study and post-placement services. If the Applicant resides outside of NB's service area, NB, in cooperation with the Applicant, will select a Local Home Study Agency to conduct direct social services. The Applicant understands and consents to the professional exchange of their information between NB and the local home study agency.

  • Department of Transportation Bridge Maintenance employees, when actually climbing the cable stays of the Penobscot Narrows Bridge for inspection and/or repair, shall be compensated at the rate of ten dollars ($10.00) an hour in addition to their regular hourly rate of pay. Employees shall be compensated for a minimum of one (1) hour of such work regardless of the length of the climbing assignment.

  • Department Chairs The release time required to perform the administrative functions of the Department Chair positions shall be deducted from the total workload of the Department Chair with no less than fifty percent (50%) of this release taken from direct instructional duties.

  • Department The Massachusetts Department of Public Utilities or any successor state agency.

  • Health & Safety (a) The Employer and the Union agree that they mutually desire to maintain standards of safety and health in the Home, in order to prevent injury and illness and abide by the Occupational Health and Safety Act as amended from time to time.

  • Department Responsibilities The use of sick leave may properly be denied if these procedures are not followed. Abuse of sick leave on the part of the employee is cause for disciplinary action. Departmental approval of sick leave is a certification of the legitimacy of the sick leave claim. The department head or designee may make reasonable inquiries about employee absences. The department may require medical verification for an absence of three (3) or more working days. The department may also require medical verification for absences of less than three (3) working days for probable cause if the employee had been notified in advance in writing that such verification was necessary. Inquiries may be made in the following ways:

  • OFFICE USE ONLY Unit Size Requested Unit Number Targeted Move-In Date Date Received Time Received _N__o__r_t_h_b__r_i_d_g__e__A__p__a__r_tm___e__n_t_s__________________ _8__0_6___T__r_o_y___R__o_a__d______________________________ _A__l_b_e__r_t__L_e__a__,_M___N___5_6__0__0_7_____________________ _P__h__:_(_5__0__7_)__4__0_2__-_3__3_7__3________________________ APPLICATION FOR OCCUPANCY Incomplete applications will be returned APPLICANT INFORMATION Applicant Name (Head of Household): First Middle Last Address: Street Address City State Zip Social Security Number: Date of Birth: [ ] Male [ ] Female [ ] Decline Applicant Phone #: Applicant Email: Alternate Phone #: Alternate Email: Emergency Contact: Name (Someone outside your household) Phone Email List All Other Household Members First MI Last Relationship to Head Date of Birth Male/Female/ Decline to Answer Social Security Number [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline Primary Language: Do you require an interpreter? [ ] Yes [ ] No How did you hear about this housing? [ ] Online [ ] Newspaper [ ] Local Agency [ ] Drive By [ ] Resident Referral [ ] Other What is the combined gross monthly income of all household members? $ ADDITIONAL HOUSEHOLD MEMBERS CURRENT HOUSING STATUS How long have you lived at your current address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: Do all adult household members live at this address?........................................................................................................................ [ ] Yes [ ] No If NO, include additional adult household’s current address and contact information on a separate piece of paper. PREVIOUS HOUSING STATUS Your previous address: How long did you live at your previous address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: List every state in which each household member has lived: ELIGIBILITY INFORMATION The following questions pertain to yourself and every member of your household who will occupy the unit. Check either Yes or No in response to each question. All questions must be answered; for those questions that do not apply, you are required to indicate so by answering “not applicable” or “n/a”.

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