Office Laboratory Assistant Employment Verification Form printable pdf download

Office Laboratory Assistant Employment Verification Form

OFFICE LABORATORY ASSISTANT EMPLOYMENT VERIFICATION FORM

Instructions: Print this form. Be prepared to upload the completed, signed and dated form during your

online application process. Instructions for submission will be provided during your online application

process.

Office Laboratory Assistant Applicant Name: _________________________________

Laboratory Director Name: _______________________________________________

Laboratory Name: _____________________________________________________

Laboratory License Number (currently licensed laboratory):____________________; OR

Laboratory Application Online Verification Number (laboratory has applied for a license but has not

received it yet):_________________________________________________________

I certify that the office laboratory assistant applicant named above is employed by the laboratory named

on this document.

Laboratory Director’s Signature: __________________________________________

Date: ________________________________________________________________

 This form must be signed by the laboratory director; no other signature will be accepted.

Office Laboratory Assistant Employment Verification Form