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Texas Standardized Credentialing Application help Form: What You Should Know
Use this handout to fill out the Texas State wide standardized credentialing application form. Fill-in the information for the name, address, email addresses and telephone number of a contact person. Use the following template for the contact person information: Name Email Phone Name, address, email address and telephone number of a contact person. Use the following template for the contact person information: Fill-in the information for the name, email address and telephone numbers of one or more contact persons. Use the following template for the contact person information: Fill-in the information for one or more information contact people. Include one contact person for your company. Name: [First, Middle (Last), Hostname]: Email: [email] Fax: [email] Telephone number: [number] Include information about the business you will establish, your background and experiences, and the scope and extent of the work you anticipate undertaking as a credentialed employee. The application must be signed and dated. Fill-in the information for the employer. Enter as much information and details as you can remember about the company, including the name of the President, Secretary and/or Business Manager. If you want to apply for a position, enter as much information as possible about yourself. Please be sure to include your full name, occupation, address, occupation, date of birth and signature. Enter as much information and details as you can remember about yourself, including the first and last name, date of birth, job experience, and telephone number. If you don't know anything about your past and career, please write down or transcribe the information you can, and be sure to include your signature. In addition to your contact person information, please use the following template for the contact person information. The application must be signed and dated. A certificate will be mailed to the address you entered in Step 1. Complete the applicant information sheet (see Section J-17). The applicant information sheet must be completed and signed by the applicant. Fill-in the appropriate information into the appropriate sections. If you wish to obtain a copy of your application, we encourage you to mail or fax it to:. Your contact person listed on the application must sign this form. If you do not want to use the Texas Standardized Credentialing Application: You must request an application form mailed by certified mail, return receipt requested.
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