Name of Firm. Supervisor: Address: Phone: City: Zip: Worker’s Disability Carrier: Policy No. Liability Insurance Carrier: Policy No. Job Title: Date Employment Begins: Ends: Hours to be worked: Mon Tue Wed Thu Fri Sat Sun Earliest Latest Avg. Hrs. Per Day*: Xxx Xxx. Per Week**: Starting Wage: *Cannot compute to more than ½ of the pupil’s FTE. **Work and school hours cannot exceed 48 hours per week for students under age 18 Unpaid Employment Information (Complete for in-district placements only) IMPORTANT: IN-DISTRICT placements MUST be directly related to one of the following: 🞏 State-Approved CTE work-based (Name of related CTE Program: ) PSN from above: 🞏 Postsecondary career and employment goals and objectives in the pupil’s transition service plan developed for special education services. A copy of the pupil’s transition services plan must be attached and relate directly to placement. Failure to do so will result in lost FTE. Position/Assignment: Supervisor: Beginning Date: Ending Date: This assignment is: (check one) 🞏 for the marking period 🞏 for the semester 🞏 for the school year Hours to be worked (must occur during scheduled classroom time): Mon Tue Wed Thu Fri Education Goals Education/Career Goal(s): List the education goals related to this placement that align with the student’s career pathway contained in the student’s educational development plan. For unpaid work-based experiences, specific, unduplicated skills must be listed for each 45 hours of placement. *Attach copy of the EDP or IEP.
Name of Firm. Address: Phone: Contact person for matters concerning MBE/WBE compliance:
Name of Firm. Address: Phone:
Examples of Name of Firm in a sentence
Name of Firm: Click here to enter text.Address: Click here to enter text.
Proposed Position: Name of Firm: Name of Staff: Profession: Date of Birth: Years with Firm: Nationality: Membership in Professional Societies: Detailed Tasks Assigned: Key Qualifications: [Give an outline of staff member’s experience and training most pertinent to tasks on assignment.
Name of Firm Address of Firm Contact Person Telephone # Fax #( ) ( ) Name or Contract No. # of Years / Term of Contract Type of Service Dollar Amt.
If a joint venture, appropriate officers of each company shall sign.) (Signature of Chief Executive Officer) (Typed Name and Title) (Type Name of Firm) Dated: APPENDIX B LETTER OF INTENT(Note: To be typed on Respondent's Letterhead.
Tender No. Name of Firm/ Company Year of Establishment Name of Owner/Authorized agent Office Address GST No. NTN.
More Definitions of Name of Firm
Name of Firm. Phone: Mailing Address: Email: Please indicate your fields of practice: Web Address: General Practice Xxxxx/Estate Planning Real Estate Tenant Issues Civil Litigation Consumer Transactions Personal Injury Bankruptcy Family Law Mediation Adoption Other: I/We agree that the following terms will govern all legal matters undertaken by myself, or my firm, on behalf of clients covered by the APEA-AFT Legal Services Plan. I/We agree to charge at a rate not exceeding One Hundred Fifty Dollars ($150.00) per hour for all legal services provided under the Plan, and not exceeding Ninety Dollars ($90.00) per hour for paralegal or law clerk services provided under the Plan; the Member cannot be charged a higher rate than allowed by the Plan for the entirety of their matter. I/We understand this rate is effective for services beginning July 1, 2017. I/We understand and agree that the Plan provides for payment of $2,000.00 per member each Plan year (July 1 thru June 30). Payment will be made at 100% for all legal services, expenses and tax covered under the terms of the Plan Booklet. Once the member has maximized their benefit for the Plan year, any payment for services performed in the same Plan year will be the member’s responsibility. I/We agree that all third party recoveries must be reimbursed to the APEA-AFT Legal Trust Fund and that no flat fee xxxxxxxx will be allowed, nor are contingency fee cases covered. I/We further understand that the Plan reserves the right to withhold payments of xxxxxxxx upon the Member's request. I/We agree to submit itemized xxxxxxxx in the name of the Member listed on the "Member Agreement" form showing daily and hourly charges of detailed services on a monthly basis (even though the case may be ongoing) to the APEA-AFT Legal Trust Fund office.
Name of Firm. Xxxxxx Xxxxxxx /S/ XXXX XXXXX ------------------------------------------ -------------------------------------------- (Authorized Signature) Address: 1221 Avenue of the Americas Title: Vice President ----------------------------------------------- -------------------------------------- Name: Xxxx Xxxxx ------------------------------------------------------ -------------------------------------- Area Code and -------------------------------------------- Telephone Number: (000) 000-0000 (Please print or type) ------------------------------------- Date: 4/12/02 --------------------------------------- Exhibit B [K Capital Partners, LLC Letterhead] April 12, 2002 Gyrodyne Company of America, Inc. 000 Xxxxxxxxxxx Xxxxxx Xx. Xxxxx, New York 11780 The undersigned (the "Seller") hereby acknowledges and agrees as to the following in connection with its sale of 111,000 shares (the "Shares") of common stock, par value $1.00 per share, of Gyrodyne Company of America, Inc. ("Gyrodyne") to Gyrodyne pursuant to that certain Settlement Agreement dated as of April 12, 2002 by and among Gyrodyne, Special K Capital Offshore Master Fund (U.S. Dollar), L.P., K Capital Offshore Master Fund (U.S. Dollar), L.P., K Capital Partners, LLC, Harwich Capital Partners, LLC, Xxxxxx Xxxxx and Xxxxx Xxxxxx.
Name of Firm. Begin: End: Supervisor: Phone: City Address: : State: Zip:
Name of Firm. Begin: End: Supervisor: Phone: City Type: Amount: Type: Amount: Address: Income sources other than employer: : State: Zip: Present Financial Institution Checking Estimated Amount: Savings Estimated Amount: Personal Information: Personal References (at least two) Name: Relationship: Address: Phone: Name: Relationship: Address: Phone: Person to contact in case of emergency Name: Relationship: Phone: Cell Phone: Address: City: State: Zip: PLEASE RETURN THIS FORM, SIGNED ALONG WITH THE XXXXXXX MONEY DEPOSIT AND CREDIT REPORT FEE TO: XXXXXXXXXX-XXXX, INC. AGENTS 000 XXXXXX XXXXXX XXXXX 000 XXXXXXXX, XX 00000 PHONE: 000-000-0000 FAX: 000-000-0000
Name of Firm. Dated this: Day of Printed Name Title Signature
Name of Firm. Firm’s Principal Office Address: (BROKER) ✔ If you check this box, this Agreement will apply to all of your branch offices, not just the branch office listed above. Please provide us with the contact information for all of your branch offices (the names of your Marketing Manager and other contacts, in addition to their addresses, phone #s, fax #s, e-mail addresses, etc.). Throughout this Agreement, COMPANY and BROKER may each be referred to as a “Party” to this Agreement, individually, and “Parties” to this Agreement, collectively. * * *
Name of Firm. Signature: Print Name: Title: [END OF EXHIBIT “H”]