Looking for a License Application Form Templates? Download it for free!

Application For Social Work License Form - Bureau Of Occupational Licenses, State Of Idaho Page 2

APPLICATION FOR SOCIAL WORK LICENSE

(continued)

AFFIDAVIT

I hereby certify that the responses provided above and those attached to this application are true and accurate to the best of my

knowledge and belief. I further certify that I am of good moral character and that I have reviewed and will comply with the Idaho

Laws and Rules, including the Code of Professional Conduct, governing the practice of Social Work.

I hereby authorize and direct any person, agency, firm, or other entity to release, upon the request of the Bureau of Occupational

Licenses or it’s authorized representative, any information, communication, report, record, statement, recommendation, or disclosure

that may have bearing on my eligibility for or maintenance of the license for which I am applying. I understand that by signing this

form I am authorizing the release of information about me that may otherwise be protected or confidential.

_____________________________________________________

Signature of applicant

State of ______________, County of _________________, ss.

Subscribed and sworn before me this ______ day of _______________________, 20 _____.

______________________________________________________

(seal)

Notary Public official signature

residing at_____________________________________________

my commission expires___________________________________

ADDENDUM 1

(complete only if you answered NO to #8 & have not yet graduated)

I hereby certify that, pending compliance with all requirements of the ___________________________________________________,

Name of institution

the applicant named above is on schedule to graduate either at the end of the current semester or within the next two quarters ending

________________ with a degree in ______________________________________ which shall be granted on __________________.

Date

__________________________________________________

(Official Institution seal)

Registrar signature

__________________________________________________

Print Registrar name

BOL – SWO-1 - 12/00

Application For Social Work License Form - Bureau Of Occupational Licenses, State Of Idaho Page 2