Sonoma County Food Handler Card Application

							                                   Sonoma County Department of Health Services 

                                                Public Health Division 

                                          Environmental Health and Safety

                                       625 5th Street  Santa Rosa, CA 95404 

                                    Phone (707) 565-6565  FAX (707) 565-6525    

                                   http://www.sonoma-county.org/environmental


                                APPLICATION FOR FOOD HANDLER CERTIFICATION

Today’s date ________________________________ Class date (call to schedule) ________________________
Name ____________________________________________________________ Phone ___________________
Mailing address______________________________________________________________________________
City ___________________________________________________ State __________ Zip ________________
Classes are filled on a first-come, first-serve basis. A completed application with payment is required to
reserve your space. Call (707) 565-6565 for availability.
Reschedule Policy: A one-time postponement to the next available class is permitted with a notice of no less
than 3 business days prior to the class/exam date.
Refund Policy: Applicants may request a refund no later than 3 business days prior to the class/exam date. A
$20 administration fee and $24.00 book fee will apply. There are no refunds for missed classes or exams.
Start Time: The class starts promptly at 8:30 a.m. Applicants registering for the test only must arrive no later than
2:30 p.m.
Valid photo identification is required for registration. Select one of the following acceptable forms of
identification and provide the number. You must also bring the selected ID with you to be admitted to the
class:
  Driver’s license       Passport         Military I.D.       State I.D. with photo
  INS Employment Authorization Document                   Alien Registration Card


No. _______________________________________ State _________                           Expiration date __________________


  Class (incl. book) + test       $134                                 Test only              $53
  Book only                       $24                                  Retest                $53


Textbook language:          English       Spanish                 Written test language:       English   Spanish


Method of payment:       Cash*       Check          Money order
                      *Do not send cash by mail.
                      Credit card:      MC         VISA No.____________________________Exp. date ____________
Name on credit card __________________________________________________________________________
Billing address_______________________________________________________________________________



                                         For office use
Amount enclosed ________________________________        Receipt# _______________________________

Method of payment:       Cash/Check          Credit card:     MC      VISA 

                                                            Exp. date ___________IN#________________


Book:    Recd. at counter        Mailed Date________________


FHC App English FY 12-13.docx                             Print                                                Rev. 052012