TERMINATION NOTICE - Texas Department of Agriculture
TERMINATION NOTICE - Texas Department of Agriculture
TERMINATION NOTICE - Texas Department of Agriculture
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COMMISSIONER SID MILLER<br />
TEXAS DEPARTMENT OF AGRICULTURE<br />
STRUCTURAL PEST CONTROL SERVICE<br />
P.O. BOX 12847, AUSTIN, TEXAS 78711-2847<br />
Phone: 866-918-4481 Fax: 888-232-2567<br />
Internet Address: www.<strong>Texas</strong><strong>Agriculture</strong>.gov/spcs<br />
<strong>TERMINATION</strong> <strong>NOTICE</strong><br />
INSTRUCTIONS:<br />
You must notify SPCS, in writing, within 10 days <strong>of</strong> the termination <strong>of</strong> an apprentice, technician or certified applicator.<br />
Use your tab or enter key to move from space to space.<br />
Name <strong>of</strong> Company OR Name <strong>of</strong> Noncommercial Entity<br />
Business License Holder OR Noncommercial Applicator<br />
TPCL No OR Noncommercial Applicator License No.<br />
Business Telephone No<br />
Business Fax No.<br />
Location Address Street City State Zip<br />
Mailing Address Street City State Zip<br />
PLEASE LIST EACH TERMINATED EMPLOYEE BELOW, LIST THE SOCIAL SECURITY NUMBER AND CHECK THE APPROPRIATE LICENSE BOX. IF THE<br />
TERMINATED EMPLOYEE IS A CERTIFIED APPLICATOR, PLEASE WRITE THE LICENSE NUMBER.<br />
NAME OF INDIVIDUAL SOCIAL SECURITY NUMBER* APPRENTICE TECHNICIAN CERTIFIED<br />
APPLICATOR #<br />
DATE<br />
TERMINATED<br />
*Disclosure <strong>of</strong> Social Security Number is mandatory under Tex Occ Code Chapt 1951.<br />
Revised 9-1-07<br />
IF ADDITIONAL SPACE IS NEEDED, PLEASE USE THE BACK OF THIS FORM.
NAME OF INDIVIDUAL SOCIAL SECURITY NUMBER* APPRENTICE TECHNICIAN CERTIFIED<br />
APPLICATOR #<br />
DATE<br />
TERMINATED
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