EYT License Renewal form Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Start date of employment * (With EYT) I will be employed as an.. * School director Sales Agent Instructor Administrator If you have a license or professional certificate related to the above instructional responsibilities, indicate the name of license/certificate and the issuing agency name and address: * *Responsibilities (if instructor, subject area to be taught) * Prior Employment Section - List most recent first * Employer name * Employer address * Address 1 Address 2 City State/Province Zip/Postal Code Country Your title * Dates of employment * Average hours per week * Specific duties * Employer #2 name (optional) Employer #2 address Address 1 Address 2 City State/Province Zip/Postal Code Country Your title Dates of employment Average hours per week Specific duties Are you a high school graduate or have you passed a general education development (GED) test? * Yes No Post high school training, including college, business school, military training, and other relevant education. * If no, please write highest grade level completed below. Location * Dates attended * Credits earned * Type of degree * Training record #2 (optional) Location Dates attended Credits earned Type of degree Have you been convicted of a misdemeanor or felony within the past seven (7) years that might unfavorably affect your fitness for this job? * Yes No If yes, please explain Thank you!
