Letter of Verification of Licensure : Please fill out the following form. Please print your completed form if you would to have a copy for your records.
Please be advised that as a condition of my employment with (Name of the company), I hereby authorize release of information relative to the status of my license or registration as a (Type of license or registration) within the state of (Sate).
Please certify below and return to:
This will certify that the above _____________ is duly licensed in the State of __________ as a ______________ and said license or registration is in good standing with no disciplinary or revocation proceedings pending.
Forms used in Employment Index
Letter of Verification of Licensure
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