Application For Arkansas Veterinary Licensure (Page 5 of 7) in pdf

Application For Arkansas Veterinary Licensure Page 5

PERSONAL DATA:

Description of Applicant:

AFFIX A PHOTOGRAPH HERE

Height: __________ Weight: __________

Eye Color: _________________________

TAKEN WITHIN 6 MONTHS

Hair Color: _________________________

Date of Photo: ______________________

LETTER OF RECOMMENDATION:

To be completed and signed by a licensed veterinarian. This statement must be notarized. No

practitioner is expected to sign this recommendation who does not know the applicant personally,

and who is not willing to supply additional information concerning his/her character upon request

from this Board.

This certifies that I have known __________________________________________ for ___________

years, that I personally knew him/her while he/she resided in (name of city) __________________

____________________in the State of ______________________; that he/she is of good moral and

professional character, that he/she is free from habits liable to interfere with his/her professional

services; that his/her standing was good in that community and is good in the community in which

he/she now lives; that he/she is worthy of receiving a license to practice veterinary medicine in the

State of Arkansas.

SIGNATURE: _____________________________________________

PRINTED NAME: __________________________________________

ADDRESS: _______________________________________________

________________________________________________________

LICENSED UNDER THE LAWS OF: ____________________________

SEAL

Subscribed and sworn to before me this __________________

day of _____________________________, 20_______________.

_____________________________________________________

Notary Public

My Commission Expires: ________________________________

Application For Arkansas Veterinary Licensure Page 5