Authorizing Signature Page Form

AUTHORIZING SIGNATURE PAGE

Is the individual signing an owner or officer?

Owner

Officer

Full Name

Title

Street Address

City

State

Zip Code

Office Phone

Fax

Mobile Phone

Under penalties of Perjury, I declare that I have examined this request and to the best of my knowledge and belief, it is true, correct and complete.

Signature

Sign Here

Date

List the additional names of those persons authorized for signing OJT documents.

Additional Staff 1

Additional Staff 2

Additional Staff 3

Additional Staff 4

Additional Staff 5

Additional Staff 6

Additional Staff 7

Additional Staff 8

An equal opportunity/employer program. Auxiliary aids and services are available upon request to individuals with disabilities.