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A-2
STEP ACTION
- ENTER BEGINNING DATE AND ENDING DATE OF THE PERIOD. THE PERIOD IS VALID FOR A MAXIMUM OF ONE YEAR.
- THE EMPLOYEE READS THE CERTIFICATION AND SIGNS THE FORM.
- PRINT EMPLOYEE'S NAME.
- ENTER THE LICENSE TYPE HELD AND NUMBER.
- ENTER THE DATE THE FORM WAS SIGNED.
- THE SUPERVISOR SIGNS THE FORM, ENTERS SIGNATURE TITLE AND DATES THE FORM.
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