FDA Procedures for Standardization and Certification
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Cover Memo
Contents
Expanded Contents
TO: FDA REGIONAL FOOD AND DRUG DIRECTOR
FROM:
SUBJECT: REQUEST FOR FDA CERTIFICATION
DATE:
| Candidate's Name: | Title: | ||||
| Office Telephone Number: | Home Telephone Number: | ||||
| Office Fax Number: & |
Office Email Address: & |
Agency: | |||
| Office Address: | City: | State: | Zip: | ||
| Home Address: | City: | State: | Zip: | ||
| Length of Service With Agency: |
| Present Duties / Date Assigned: |
| Prior Retail Experience: | Dates: |
| Formal Education/ Training Background: |
| Continuing Education: (List hours of education with course titles/dates, within the last 2 years) Note: 20 contact hours minimum to qualify for nomination. |
| Other Prerequisites Completed: |
SUPERVISOR'S SIGNATURE (Confirming request for nomination):
NAME (Print):_________________________________
NAME (Signature):______________________________ &&&Date:_____________
TITLE:________________________________________
Retail Food Inspections Table of Contents