NH Dept. of Administrative Services
1552575-704849Registration FormAll Professional Development CoursesLean White, Yellow & Green BeltsLean Green & Black Belt RefreshersDivision of PersonnelBureau of Education and Training28 School Street – State House Annex Room 24Concord, NH 03301BET@ 00Registration FormAll Professional Development CoursesLean White, Yellow & Green BeltsLean Green & Black Belt RefreshersDivision of PersonnelBureau of Education and Training28 School Street – State House Annex Room 24Concord, NH 03301BET@ -85726-58102500Course Date: FORMTEXT ?????Course Name: FORMTEXT ?????Course Cost:$ FORMTEXT ?????Personal & Current Work Information:?Name: FORMTEXT ?????Agency: FORMTEXT ?????Work Address: FORMTEXT ?????City: FORMTEXT ????? Work Email Address: FORMTEXT ?????Phone/Ext: FORMTEXT ?????Title: FORMTEXT ?????Department: FORMTEXT ?????Division: FORMTEXT ?????Supervisor: FORMTEXT ?????Phone/Ext: FORMTEXT ??????Email: FORMTEXT ?????Current Job Responsibilities: FORMTEXT ?????Signatures:Applicant: ____________________________________Date: ? FORMTEXT ??????Supervisor’s Support Statement: “My signature below indicates that I fully support this candidate’s entry into the Lean Program(s) offered by Bureau of Education and Training and that funding has been approved.”??Supervisor: _____________________________________Date: FORMTEXT ??????Additional Signature: _____________________________Date: FORMTEXT ?????If necessaryS:Training/Applications/Registration FormRev: 3/2/2017 ................
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