ࡱ> %` tUbjbjNN 6,,8  %%%8%&VHhL'J,,,,-B1<4 GGGGGGG$Ih&LG]8--88G,,H>>>8,,G>8G>>:YC,C,@' PG6\%9C !Dl&H0VHCRL':LCLC@%55>g6l6%5%5%5GG?>p%5%5%5VH8888$$#d$# Virginia Department of Labor and Industry 13 South Thirteenth Street, Richmond, Virginia 23219 CONSULTATION TRAINING REGISTRATION FORM PERSONAL INFORMATIONFirst Name:  FORMTEXT      Last Name:  FORMTEXT      Middle Initial:  FORMTEXT      Suffix: (i.e.: Jr., Sr., II, III)  FORMTEXT      Work Title:  FORMTEXT       COMPANY/ORGANIZATION INFORMATIONCompany/Organization Name:  FORMTEXT      SIC  FORMTEXT      NAICS  FORMTEXT      Co. Address 1: (Street Address)  FORMTEXT      Co. Address 2: (Bldg. No., Suite No.)  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT      Zip Code:  FORMTEXT      Work Phone: ( FORMTEXT    )  FORMTEXT      Extension: (if any)  FORMTEXT      Mobile Number: ( FORMTEXT    )  FORMTEXT      Fax Number: ( FORMTEXT    )  FORMTEXT      E-mail Address:  FORMTEXT      Total # Employees:  FORMTEXT       CLASS IDENTIFICATION (see HYPERLINK "http://www.doli.virginia.gov/whatwedo/coop_prog/training/training2006.htm"course listings on the web) COURSE NUMBERDESCRIPTIONLOCATIONDATE *TIME FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FOT < > V X l n p z | ~ ÿ{eRe%j0h!s CJOJQJU^J*jh!s CJOJQJU^JmHnHu%jh!s CJOJQJU^Jjh!s CJOJQJU^Jh!s 5CJOJQJ\^Jh!s CJOJQJ^J h!s CJh!s h!s 5OJQJ\^J h!s 9h!s 5CJOJQJ\^Jh!s 6CJOJQJ]^Jh!s 5OJQJ\^J < > V ~  yssssss$Iftkd$$Ifl4*+  064 laf4p $If$a$ pTrU     F H J ^ ` b l n r ܺ~ܑkܑ\P@PjhzCJOJQJU^JhzCJOJQJ^Jhz5CJOJQJ\^J%jh!s CJOJQJU^J$h!s h!s CJOJQJ^JmH sH $h!s h!s CJOJQJ^JmH sH *h!s h!s 5CJOJQJ\^JmH sH h!s CJOJQJ^J*jh!s CJOJQJU^JmHnHujh!s CJOJQJU^J%jh!s CJOJQJU^J p r [kd$$Ifl4\8 *    064 laf4$If 4 6 J L N X Z ܺm^Em,m0jhv5CJOJQJU\^JmHnHu1jNhvh[!5CJOJQJU\^Jhv5CJOJQJ\^J%jhv5CJOJQJU\^Jh5CJOJQJ\^Jh!s CJOJQJ^Jh!s 5CJOJQJ\^Jh!s hz5CJOJQJ^JhzCJOJQJ^J*jhzCJOJQJU^JmHnHujhzCJOJQJU^J%jhzCJOJQJU^J rkd$$Ifl4*+  064 laf4p $Iffkd$$Ifl4*+064 laf4yt5\9 4 \ d  * v kkd$$Ifl4F%*06    4 laf4yt$If Z \ b d f z | ~ ĸČ}n[B[1j>hvh[!5CJOJQJU\^J%jhv5CJOJQJU\^Jh5CJOJQJ\^JhhCJOJQJ^J*jhvCJOJQJU^JmHnHu+jhvh[!CJOJQJU^JhvCJOJQJ^JjhvCJOJQJU^Jh5CJOJQJ^Jh!s h5CJOJQJ^Jhv5CJOJQJ\^J      & ( * F H v x ¶s`sJss7%jhzCJOJQJU^J*jhzCJOJQJU^JmHnHu%jhzCJOJQJU^JjhzCJOJQJU^JhzCJOJQJ^JhzCJOJQJ^JhzCJOJQJ^Jhz5CJOJQJ\^JhCJOJQJ^J"hh5CJOJQJ\^J%jhv5CJOJQJU\^J0jhv5CJOJQJU\^JmHnHu     4 6 8 B D H ` b d x z | ;ͫ;͘;ͅ;r%j hzCJOJQJU^J%jm hzCJOJQJU^J%jhzCJOJQJU^J%jhzCJOJQJU^Jhz5CJOJQJ\^JhzCJOJQJ^J*jhzCJOJQJU^JmHnHujhzCJOJQJU^J*  F H ` Jkd $$Ifl4r\ "%*  5064 laf4$If  "68:@BFH\^`jlnܺܺܺܺyܺܺfܺܺ%j hzCJOJQJU^J%jh hzCJOJQJU^J%j hzCJOJQJU^JhzCJOJQJ^Jhz5CJOJQJ\^JhzCJOJQJ^J*jhzCJOJQJU^JmHnHujhzCJOJQJU^J%j| hzCJOJQJU^J$ n$]kd@$$Ifl4\V H<*  ` 064 laf4$If  "$FJL`bdnprtvxܺܺܺܺܺuhܺUu%jhzCJOJQJU^Jhz5CJOJQJ^Jh!s hz5CJOJQJ^J%jMhzCJOJQJU^Jhz5CJOJQJ\^J%j hzCJOJQJU^JhzCJOJQJ^J*jhzCJOJQJU^JmHnHujhzCJOJQJU^J%jT hzCJOJQJU^J!$Jrtv}w$Ifykd7$$Ifl40 !*x! 064 laf4ytz $Ifgd5\9vxz|||$If$Ifrkd$$Ifl4*+  064 laf4p x|\^`~ "$8Ƕ{fN{{.jh!s CJOJQJU^JaJmHnHu)jh!s CJOJQJU^JaJh!s CJOJQJ^JaJ#jh!s CJOJQJU^JaJh!s 5CJOJQJ\^Jh!s CJOJQJ^J h!s 5CJOJQJ\^JaJ h!s aJh!s 0JCJjh!s CJUjh!s CJU h!s CJh!s h!s OJQJ^Jkd$$Iflr,#*LL  20P+64 lap2"Jr<OkdM$$Iflr,#*LL 0P+64 la d$If 8:<FHJL`bdnprtزززnXEX%jh!s CJOJQJU^J*jh!s CJOJQJU^JmHnHu%j]h!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^J)jh!s CJOJQJU^JaJh!s CJOJQJ^JaJ.jh!s CJOJQJU^JaJmHnHu#jh!s CJOJQJU^JaJ)jmh!s CJOJQJU^JaJ*,.8:<>RTVܚ܅uiVu%jh!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^J)j h!s CJOJQJU^JaJ)jh!s CJOJQJU^JaJ.jh!s CJOJQJU^JaJmHnHu)jh!s CJOJQJU^JaJh!s CJOJQJ^JaJ#jh!s CJOJQJU^JaJh!s V`bdfz|~ληjUj)jh!s CJOJQJU^JaJ.jh!s CJOJQJU^JaJmHnHu)jCh!s CJOJQJU^JaJh!s CJOJQJ^JaJ#jh!s CJOJQJU^JaJh!s %jh!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^J*jh!s CJOJQJU^JmHnHu<d.VOkdt$$Iflr,#*LL 0P+64 la d$If *,.0DFHRTVXZnpr|زmZmVزA)jjh!s CJOJQJU^JaJh!s %j#h!s CJOJQJU^J*jh!s CJOJQJU^JmHnHu%jh!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^Jh!s CJOJQJ^JaJ.jh!s CJOJQJU^JaJmHnHu#jh!s CJOJQJU^JaJ)j3h!s CJOJQJU^JaJVX JXOOOOO d$Ifkd$$Iflr,#*LL 0P+64 la|~JJߝߍnXVU*jh!s CJOJQJU^JmHnHu%jh!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^J)jZh!s CJOJQJU^JaJ.jh!s CJOJQJU^JaJmHnHu)jh!s CJOJQJU^JaJh!s CJOJQJ^JaJ#jh!s CJOJQJU^JaJRMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       For special training needs, please contact Nick Hart at (804) 692-0096, HYPERLINK "mailto:consultationtraining@doli.virginia.gov"consultationtraining@doli.virginia.gov. Instructions: Please complete registration legibly. (We would like to ensure that your name is printed accurately on your certificate). Type in or write down the date and time of the courses you would like to attend. Press the  Tab key to go to the next field. Save this form as  lastname_trainingregistration.doc in your computer. Send the completed form to: (Attention: Consultation Training) E-mail: HYPERLINK "mailto:consultationtraining@doli.virginia.gov"consultationtraining@doli.virginia.gov or Fax: (804) 786-8418     Virginia Department of Labor and Industry ( Consultation Training ( Registration Form ( Rev:08/05( Page  PAGE 1 JJJJJ J"J$J8J:JKRKTKVK`KbKdKfKzK|K~KKKKKKKKKKKزززnXEX%j%h!s CJOJQJU^J*jh!s CJOJQJU^JmHnHu%j4%h!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^J)j$h!s CJOJQJU^JaJh!s CJOJQJ^JaJ.jh!s CJOJQJU^JaJmHnHu#jh!s CJOJQJU^JaJ)jD$h!s CJOJQJU^JaJKKKL.LVL~LSJJJJJ d$Ifkd$&$$Ifl4r,#*LL 0P+64 laf4KKKKKKKKKKKKKLLLLLL L*L,L.L0LDLFLHLܚ܅uiVu%je(h!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^J)j'h!s CJOJQJU^JaJ)ju'h!s CJOJQJU^JaJ.jh!s CJOJQJU^JaJmHnHu)j&h!s CJOJQJU^JaJh!s CJOJQJ^JaJ#jh!s CJOJQJU^JaJh!s HLRLTLVLXLlLnLpLzL|L~LLLLLLLLLLLLLLLLLLληjUj)j*h!s CJOJQJU^JaJ.jh!s CJOJQJU^JaJmHnHu)j.*h!s CJOJQJU^JaJh!s CJOJQJ^JaJ#jh!s CJOJQJU^JaJh!s %j(h!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^J*jh!s CJOJQJU^JmHnHu~LLLLL MHMSJJJJJ d$IfkdU)$$Ifl4r,#*LL 0P+64 laf4LLLLLLLMMMMM M"M6M8M:MDMFMHMJMLM`MbMdMnMزmZmVزA)j_-h!s CJOJQJU^JaJh!s %j,h!s CJOJQJU^J*jh!s CJOJQJU^JmHnHu%j+h!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^Jh!s CJOJQJ^JaJ.jh!s CJOJQJU^JaJmHnHu#jh!s CJOJQJU^JaJ)j+h!s CJOJQJU^JaJHMJMrMMMMNSJJJJJ d$Ifkd,$$Ifl4r,#*LL 0P+64 laf4nMpMrMtMMMMMMMMMMMMMMMMMMMMMMNNߝߍnXE%j?/h!s CJOJQJU^J*jh!s CJOJQJU^JmHnHu%j.h!s CJOJQJU^Jh!s CJOJQJ^Jjh!s CJOJQJU^J)jO.h!s CJOJQJU^JaJ.jh!s CJOJQJU^JaJmHnHu)j-h!s CJOJQJU^JaJh!s CJOJQJ^JaJ#jh!s CJOJQJU^JaJNNNNNNN*N,N.N8N:NNRNTNVN`NbNdNfNzN|N~NNNNNNɷ|g|R|)j1h!s CJOJQJU^JaJ)j1h!s CJOJQJU^JaJ.jh!s CJOJQJU^JaJmHnHu)j0h!s CJOJQJU^JaJh!s CJOJQJ^JaJ#jh!s CJOJQJU^JaJh!s h!s CJOJQJ^J*jh!s CJOJQJU^JmHnHujh!s CJOJQJU^JNNP@PDPdPPܺܺܺzjzWjIjzzh!s 0JCJOJQJ^J%j4h!s CJOJQJU^Jjh!s CJOJQJU^Jh!s CJOJQJ^Jh!s 5CJOJQJ\^Jh!s CJOJQJ^JaJh!s %jp2h!s CJOJQJU^Jh!s CJOJQJ^J*jh!s CJOJQJU^JmHnHujh!s CJOJQJU^J%j1h!s CJOJQJU^JNNNNNNSMMDD $$Ifa$$Ifkd2$$Ifl4r,#*LL 0P+64 laf4NNNDPFPHP53333kd3$$Ifl4\,#*  (0P+64 laf4p(HPdPZQQVRRdS@< Title$a$CJOJQJ^JHJ@H Subtitle$a$59OJQJ\^J6U@6 Hyperlink >*B*ph4"4 Header  !4 24 Footer  !.)@A. 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