License Number. 000108F. Notice is hereby given that the Orders revoking the following licenses are being rescinded by the Federal Maritime Commission pursuant to sections 14 and 19 of the Shipping Act of 1984 (46 U.S.C. app. 1718) and the regulations of the Commission pertaining to the licensing of Ocean Transportation Intermediaries, 46 CFR part 515. License Number Name/Address
License Number. (The facility/provider license number for each facility to be accessed under this account must be provided. Otherwise, indicate staffing agency applicable. ) or independent contractor as Please submit only one Provider End-User Security Agreement. The holder of the account established by this agreement will act as an administrator of accounts for all related entities identified with this application. The account holder will be responsible for collecting and maintaining End-User Security Agreements for any additional accounts created in OK-SCREEN for the identified related entities and for issuing and maintaining those accounts. The holder of the account established by this agreement may create additional administrator accounts for their related entities. First Name: Middle Initial: Last Name: Provider End User Security Agreement The Oklahoma Screening and Registry Employee Evaluation Network (OK-SCREEN) is password protected. You must register and secure a username and password before you access the secured site. Username and passwords are not to be shared at any time. All users must secure a user name and password from an authorized Oklahoma State Department of Health (OSDH) OK-SCREEN Systems Administrator or Provider User Administrator. You and your company are entirely responsible for maintaining the confidentiality of your username and password. Provider User Administrators are responsible for disabling the user accounts of terminated employees. Furthermore, you and your company are entirely responsible for all activities that occur on this site. You or your company must notify the OK-SCREEN program office immediately of any known or suspected unauthorized use of your username and password or any other breach of security. Contact the OK-SCREEN program office at (000) 000-0000 or send an E-mail to xxxxxxxx@xxxxxx.xx.xxx. Address: Proposed User Name: Phone#: Email: My signature acknowledges and confirms that I have read, understand, and accept the terms and conditions as stated in this Provider End User Security Agreement form. Signature of Account Applicant Date THIS FORM REQUIRES THE SIGNATURE OF AN AUTHORIZED OFFICER OF THE LICENSED OPERATING ENTITY. THIS IS GENERALLY NOT THE ADMINISTRATOR Printed Name of Authorized Person Signing for the Licensed Operating Entity Official Title or Position Signature of Authorized Person Date E-mail the completed form to xxxxxxxx@xxxxxx.xx.xxx
License Number. C04DU1066 DISCIPLINE POLICY Cornerstone reserves the right to accept or not accept any new or returning student for enrollment. We are not a school for students with habitual behavioral issues, and our mission is not to provide behavioral or psychological therapy for any child. The overall effectiveness of the programs and emotional well-being of every child at CCS is an overriding concern. In the event, it is determined by Cornerstone’s Administrators that a student is being unruly, with uncontrollable behavior, disruptive, violent/dangerous to other students, or to a CCS staff member(s), such student will, at the sole discretion of CCS be involuntarily withdrawn. Any debts owed to CCS will be immediately due. CCS is not required to explain its reasoning for expulsions and/or involuntarily withdrawals. All expulsions and involuntarily withdrawals decisions are final and cannot be overridden by any member of CCS Staff. By signing this contract, the parent(s)/account xxxxxx agrees to support the disciplinary methods used by the school.
License Number. 220000083
License Number. Phone:.......................................... Fax:......................................... Mobile:............................... Email:..............................
License Number. Date of Interview with Student: I understand and agree to the conditions listed above. Student Signature: Date: Supervising Dentist Signature: Date: Direct Supervisor Signature – if different from above Date: Internship Director Signature: Date: Return form to Internship Director: Xx. Xxx XxXxxxxxxx 000 Xxxxxxx Xxxxx Rangely, CO 81648 Phone : (000) 000-0000 x000 or (000) 000-0000 Fax: (000) 000-0000
License Number. 2. Project Name, Number, & Location: Sample Project, Federal Project No. XX County Project No. XX, Sample Area
License Number. Contractor’s Oregon Contractor’s license number is 189246.
License Number. 2. Tenant agrees to the following terms
License Number. GMP conformance statement for manufacturing site (or a separate authorities issued GMP certificate for the manufacturing site) • Zone IV stability data (30 degrees Celsius and 75% relative humidity which will be provided to Teva following the manufacturing of three consecutive batches of the Product) according to the international conference on harmonization of technical requirements for the registration of pharmaceuticals for human use (ICH), XXXXXXXX X Trademarks APPENDIX F Quality Agreement APPENDIX G Pharmacovigilance Agreement APPENDIX H ANTI-CORRUPTION LAW ACKNOWLEDGMENT AND CERTIFICATION 3 Galena confirms that should it learn of or have reason to know of any activities in connection with its compensation by Teva which may constitute a violation of the applicable anti-corruption laws, it will immediately advise Teva’s representative.
