Get Form-079licenseecertification.doc - Dopl Utah

The Form-079licenseecertification.doc is an essential document for individuals under probationary status with the Division of Occupational and Professional Licensing in Utah. This guide provides a comprehensive overview of how to accurately fill out the form online, ensuring all necessary information is included for proper submission.

Follow the steps to complete the Form-079licenseecertification online.

1. Click the ‘Get Form’ button to access the document and open it in your preferred editor.
2. In the first section, fill in your case number in the designated field labeled 'Case #:'.
3. Next, enter your full name and profession in the 'I, (print name and profession)' field.
4. Select the appropriate checkbox to indicate the individual you have informed about your probationary status. You may choose multiple options if necessary.
5. In the field for the date, provide the date the Stipulation and Order/Memorandum of Understanding was signed.
6. Specify the term of your probation in the corresponding field, indicating the number of years from the signing date.
7. Sign in the 'Signature' section and write the date next to your signature.
8. Printed name should be entered clearly in the designated area following your signature.
9. The verification section should be filled out by the appropriate individual who received the document. They will print their name and the entity they represent.
10. Lastly, the verifying individual should complete their signature, date, printed name, title, email address, and phone number.
11. Once all fields are completed, review the document for accuracy. Save changes, then you can download, print, or share the completed form as necessary.

Complete your Form-079licenseecertification online today to ensure compliance with the Division of Occupational and Professional Licensing.