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Get Utah Captain License Form 2011-2024

Or information provided to the Division or my employer will result in the revocation of my license/permit. Applicant s signature Date / / E-mail APPLICANT S EMPLOYER I certify the applicant named above is employed by and I have verified the required: experience listed on this application, first aid, and CPR to obtain the license/permit applying for. q Experience q First Aid q CPR q Applicant information verification Authorized agent s signature E-mail Date q NASBLA (if applicable).

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