I,. , in the presence of the. (Name of affiant) undersigned notary public, under oath or affirmation make the following statements: (Signature of affiant).Please type or print legibly. • Complete a form for each employer in order to meet the required experience for your application. Instructions for Completing Affidavit Required to Become Licensed – for information only. I received a letter from the 3rd Dept. Affidavit specifying his or her financial circumstances in the form set forth herein.