THE FOLLOWING INFORMATION IS USED FOR:

1. Printing your certificate.
2. Mailing your certificate.
3. Filing record with the State database.

Please note that the applicant’s delivery (home) address and phone number must not be the same as the employer (facility) information unless it is also their place of residence. Please enter values as accurately as possible, as any inaccuracies or missing information will cause a delay in the certification process.