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TEXAS DEPARTMENT OF STATE HEALTH SERVICES RADIOACTIVE MATERIALS LICENSING GROUP MC2003, ZZ113-120 P.O. Box 149347 Austin, TX 78714-9347 RC Form 255-R (Rev. 10/13) ZZ113-120 FOR AGENCY USE ONLY ID.

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How to fill out the RC Form 255-R online

Filling out the RC Form 255-R is an essential step for individuals seeking to qualify as radiographers in Texas. This guide provides clear, step-by-step instructions to facilitate the online completion of the form.

Follow the steps to successfully complete the RC Form 255-R online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering your personal data in Section I. Provide your full name, date of birth, and social security number. Ensure that you type or print legibly.
  3. In the mailing address field, input your current address along with your phone number. Ensure accuracy for proper communication regarding your application.
  4. Check the appropriate box to indicate whether you are applying for radioactive materials only, x-ray machines only, or both.
  5. Move to Section II to document your on-the-job training hours. Ensure that you have at least 200 hours for radioactive materials and/or 120 hours for x-ray machines documented, starting from the OJT start date listed on the trainee status card.
  6. If applicable, complete Section III with your current employer's information. Obtain the required signatures from both you and your Radiation Safety Officer (RSO).
  7. In Section IV, certify that the information provided is accurate to the best of your knowledge. Sign and date the form.
  8. If necessary, use additional pages to document your on-the-job training records. Each day of training must be recorded separately.
  9. Once you have filled out the form completely, you can save your changes. After saving, proceed to download, print, or share the completed form as required.

Complete your RC Form 255-R online today to advance your aviation career.

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