PAR INSTRUCTOR CANDIDATE EXPERIENCE SHEET by qfa20129

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									                  FLORIDA DEPARTMENT OF JUVENILE JUSTICE
                  PAR INSTRUCTOR CANDIDATE FORM

Printed Name of Candidate: ____________________________________________

Instructions : Complete this form, and provide it to the PAR Instructor at the beginning of the Train-the-Trainer
course. All three criteria must be met before admission to the course will be allowed. The candidate and his or
her Administrator must sign and date this form.

EXPERIENCE
The PAR Instructor candidate must have one year of experience in the juvenile justice or related field. The one-
year experience requirement is based upon full-time hours. For example, if you have been in your current
juvenile justice position for one year as a part-time employee, this only fulfills half of the one-year experience
requirement. You may attach additional sheets, if necessary.

Name of Employer: ________________________________________________________________________________
Address: _________________________________________________________________________________________
Telephone: (______) _____________________             Job Title: _______________________________________________
Supervisor’s Name: ______________________________________________________                     Hours Per Week: _________
From: ______/______/______            To: ______/______/______

Duties and Responsibilities:




PAR CERTIFICATION
 Attached is my documentation of PAR certification. I was certified in: (Check one.)
              PAR for Program Staff           PAR for Facility Staff
INSTRUCTOR TECHNIQUES WORKSHOP (ITW) CERTIFICATION
 Attached is my documentation of ITW certification.
I hereby attest that all information in, or attached to, this document is true and correct.
______________________________________________________                  _____/_____/_____
Candidate’ s Signature                                                   mth   day   year

_______________________________________________             ____________________________________       _____/_____/_____
P rint Name o f Ad ministrator                              Signature                                   mth   day   year




                                                                                                                    8/15/03

								
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