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Nevada Certificate of Employment

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Nevada Certificate of Employment Powered By Docstoc
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                                                                          Occupational and Business Licensing
                                                                                              555 Wright Way
                                                                                  Carson City, NV 89711-0100
                                                                                               (775) 684–4690
                                                                                             www.dmvnv.com

                                               CERTIFICATE OF EMPLOYMENT

Please type or print in ink.                                                                           FEES
   Salesman                                                        New                            $
   Inspector                                                       Renewal                        $
  Class:                                                           Transfer                       $
            One                Two
            Gas                Diesel
     Drive School Instructor                                       Behind the Wheel
            CDL                Non CDL                             General Classroom
     DUI School Instructor                                         General Classroom Under 18
     Traffic Safety School Instructor                              Trainee

EMPLOYEE:

Full Legal Name                                             Occupational License No.

Mailing Address                                                    City               State           Zip

Physical Address                                                   City               State           Zip

Phone No: (                    )

Social Security No                 -       -                          Date of Birth                   Sex

Height                             Weight                   Hair                       Eyes

I certify under penalty of perjury that all information contained in this application is true and correct.

Employee’s Signature                                                                      Date:

EMPLOYER:

Business Name                                               Business License No.

Address

City                               State                    Zip                        Phone No:

Authorized Representative's Name and Title (Print) :


Authorized Representative’s Signature:
OBL-236 (4-2006)

				
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