Name of Applicant. Address: Apt. City, State, Zip: Phone (home) : (work): (fax): Email Address: Emergency Contact name & number: Editor name & number: TERMS & CONDITIONS AGREEMENT / RELEASE (Please read carefully) I hereby certify that I am an independent contractor, assuming all responsibility for myself as a result of my participation in Xxxxxxxx Grove Speedway events. I am not an employee, servant, or agent of Xxxxxxxx Grove. I hereby agree to abide by all rules and regulations of Xxxxxxxx Grove Speedway or Credentials will be revoked at anytime Print / Photos - The Xxxxxxxx Grove Speedway media accreditation terms and conditions include (but are not limited to) the provision that any stories produced and/or still photographs taken at each event will be used for media purposes only and Not for Commercial use or sale. Media credentials are not intended for those who sell photos or images for purposes other than editorial coverage. Credentials WILL NOT be issued to those involved in commercial ventures, unless written consent is obtained from Xxxxxxxx Grove Speedway. Television/Video/Broadcast-, Xxxxxxxx Grove inc. maintains the exclusive right to film/broadcast or Live Streaming Xxxxxxxx Grove Speedway events and reserves the right to restrict access to any video or audio recording devices at any time without notice. In all cases, prior approval and notification of presence is required before videotaping or Live Streaming The undersigned understands and agrees that he/she and beneficiaries, executors and assigns will be entitled to the benefits of insurance coverage provided by Xxxxxxxx Grove Speedway for accidental injuries or death which occur as the result of external, violent and visible means, sustained during Xxxxxxxx Grove events. The coverage of said policy shall constitute the limit of liability of Xxxxxxxx Grove, Inc. for such injuries occurring to the undersigned in any Xxxxxxxx Grove event, provided proper notification of such occurrence is filed with Xxxxxxxx Grove, Inc. management prior to that person leaving the speedway property. The undersigned fully understands that a race car exposes him/her to risks which can lead to serious bodily injury or death. The undersigned voluntarily assumes these risks. WITH MY SIGNATURE BELOW, I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT. I AGREE TO ABIDE BY ALL TERMS OF THIS AGREEMENT AND THE RULES OF Xxxxxxxx Grove SPEEDWAY. Please return this form (signed and dated) to: Xxxxxxxx Grove Credential 1 Speedwa...
Name of Applicant. Mailing Address: County: Phone #: Email address: Applicant Signature: Print Name: Date:
Name of Applicant. ILLUMINET, INC. a Delaware corporation ("Applicant") Address: 4501 Xxxxxxx Xxxx, X.X. Xxxxxxx, XX 00000 Xxplicant hereby applies to Rural Telephone Finance Cooperative ("RTFC"), a South Dakota cooperative association, for a revolving line of credit loan in an amount not to exceed seven million three hundred thousand ($7,300,000). Applicant hereby agrees that in the event RTFC approves this Agreement, the terms and conditions herein and any additional terms and conditions as approved by RTFC, and as agreed to in writing by Applicant, shall constitute a valid and binding agreement between Applicant and RTFC. In consideration of their mutual promises hereunder and other valuable consideration, the receipt and sufficiency of which is hereby acknowledged, RTFC and Applicant agree to the following terms and conditions:
Examples of Name of Applicant in a sentence
Name of Applicant: (Consult the Authorized User section of the Radiation Safety Manual for instructions on completing the following sections.) 2.
Printed Name of Applicant Signature of Applicant O.C.G.A. § 45-17-6 requires legible seals for notarized documents.
Name of Applicant Authorized Representative* TitleEmailPhone *Individual holding signatory authority to sign this application form and enter the Applicant into a Grant Agreement with MEA, if awarded (e.g.Chair of the Board of Education, Chief Financial Officer, General Manager, etc).
APPLICANT DETAILS Name of Applicant Type of Entity(Individual /Organization; profit / non-profit) Business Registration Number (for organisation) Contact Person Address Email Address & website Telephone / Mobile phone PROPOSED AREA OF SERVICES[Please select how your knowledge, skills, experiences, and qualifications meet each of these service categories.]1.
CHAIRPERSON DATE FOR RSOF USE ONLY APPROVALAPPLICATION FOR NON-HUMAN USE OF RADIOACTIVE MATERIALS (RAM) LABORATORY PERSONNEL LIST Office use only: PLG # PI# Name of Applicant: List the names of all personnel in your laboratory who will use radioactive materials.
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Name of Applicant. Address: Phone #: Fax #: E-Mail Address:
Name of Applicant. Phone Number: Address: Name of activity: Date Requested: Total Amount Due: $125.00 This agreement executed by and between Soo Township, hereinafter (Date) called the Lessor, at 3 ½ Mile Road, and
Name of Applicant. VIRGIN ISLANDS TELEPHONE CORPORATION, a Virgin Islands corporation ("Applicant") Address: X.X. Xxx 0000 Xx. Xxxxxx, U.S. Virgin Islands 00801 Applicant hereby applies to Rural Telephone Finance Cooperative ("RTFC"), a South Dakota cooperative association, for a revolving line of credit loan in an amount not to exceed five million dollars ($5,000,000). Applicant hereby agrees that in the event RTFC approves this Agreement, the terms and conditions herein and any additional terms and conditions as approved by RTFC, and as agreed to in writing by Applicant, shall constitute a valid and binding agreement between Applicant and RTFC. In consideration of their mutual promises hereunder and other valuable consideration, the receipt and sufficiency of which is hereby acknowledged, RTFC and Applicant agree to the following terms and conditions:
Name of Applicant. Location: Reason for Request: Date(s) leave taken: Date Filed: Prepare one copy. Route through administrator/ supervisor to the Human Resource Office for approval. A letter will be sent to the employee informing them of approval/disapproval. Emergency Leave is charged to the employee’s Sick Leave bank. Administrator’s / Supervisor’s Recommendation Date Human Resources Signature Date Disposition from HR: APPROVED NOT APPROVED APPENDIX H – REQUEST FOR TRANSFER FORM CENTRAL KITSAP SCHOOL DISTRICT NO. 401 REQUEST FOR TRANSFER 20 _-20 _ (Continuing Non-Provisional Employees for the upcoming year ONLY) For your privacy concerns, interview/hiring teams do not have access to your personnel file. The information you include on this form will be provided to the hiring team. The front side of this form is required information and the backside is optional information. The district transfer process takes place in the spring after the March 1 deadline. We will work to enable as many of the transfer requests as possible. To be considered for transfer, an employee must be on a Continuing Non- Provisional Contract for the upcoming school year. Print Name: Current Location: Current Assignment: Certificate (*K-8, K-12, or Standard Elem / Sec): Endorsement(s): Major: Minor: I have an unused involuntary transfer status “chit(s)”. Year(s): Transferred from to
Name of Applicant. Location: Reason for Request: Date(s) leave taken: Date Filed: Prepare one copy. Route through principal / supervisor to the Human Resource Office for approval. A letter will be sent to the employee informing them of approval/disapproval. Emergency Leave is charged to the employee’s Sick Leave bank. Principal’s / Supervisor’s Recommendation Date Human Resources Signature Date Disposition from HR: APPROVED NOT APPROVED APPENDIX H CENTRAL KITSAP SCHOOL DISTRICT NO. 401 REQUEST FOR TRANSFER 200_-200_ (Continuing Non-Provisional Employees for the upcoming year ONLY) For your privacy concerns, interview/hiring teams do not have access to your personnel file. The information you include on this form will be provided to the hiring team. The front side of this form is required information and the backside is optional information. The district transfer process takes place in the spring after the April 1 deadline. We will work hard to enable as many of the transfer requests as possible. To be considered for transfer, an employee must be on a Continuing Non-Provisional Contract for the upcoming school year. Print Name: Current Location: Current Assignment: Certificate *K-8, K-12, or Standard Elem / Sec): Endorsement(s): Major: Minor: I have an unused involuntary transfer status “chit(s)”. Year(s): Transferred from to € Request must be specific to preferred buildings and preferred assignments: Building Requested Teaching Assignment Requested 1st 2nd 3rd 4th 5th Employee Signature Date You might want to provide additional information to the principal/team to consider. On the back of this form are some ideas for this information. Again, it is optional information, but it could work to your benefit. OPTIONAL INFORMATION FOR INTERVIEW / HIRING TEAM • Describe your current school / teaching assignment (especially if there are special aspects, i.e., multiage, team teaching, etc.) • Describe your employment history as it would apply to a position for which you would wish to be considered. • Describe special skills / talents you might bring to new position. • Describe why you are asking for a transfer. • Describe your ideal teaching situation. • Other information you would like to be considered. See the Collective Bargaining Agreement for full transfer information. APPENDIX I CENTRAL KITSAP SCHOOL DISTRICT NO. 401 Silverdale, Washington SABBATICAL LEAVE APPLICATION FORM Application for Sabbatical Leave must be made by April 1 to the Human Resources Office.
Name of Applicant. Contact Person: Address: Email address:
Name of Applicant. Address: City: Postal Code: Phone: Date of Event: Description of activities involved: Precise location of the closure requested (intersection to intersection or house number Required Signs and Barricades to house number): From to The TC-53A or 53B barricades shall be used for short-term road closures to prevent vehicles from entering the designated area. The Road Closed Sign (RB92) shall be used where a roadway must be temporarily closed and traffic must use an alternate route. Street Name: Proposed start and finish time (the event must finish no later than midnight): From am / pm to am / pm Checklist of Requirements All of the following may or may not apply in all situations. Contact the City of Brampton's Public Works division for details. Applicant must: