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ALIST ASSISTANT CERTIFICATION OF EXPERIENCE APPLICANT INSTRUCTIONS 1. 2. 3. Complete Section I in ink. Enter your name as it appears on your Licensure Application (Form 1). Be sure to sign and date item 10. Send this form to the supervisor(s) with whom you worked to complete Section II and the certification. A separate Certificate of Experience should be submitted by each employer. This form must be signed by the supervisor certifying your professional experience and must be returned directly.
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