- Legal
- United States Legal Forms
- Florida Legal Forms
- Florida Department of Health
Documents
82
!["Verification of Employment/Loss of Income Form" - Sarasota County, Florida](https://data.templateroller.com/pdf_docs_html/327/3279/327994/verification-employment-loss-income-form-sarasota-county-florida.png ""Verification of Employment/Loss of Income Form" - Sarasota County, Florida")
"Verification of Employment/Loss of Income Form" - Sarasota County, Florida
Size: 123 KB
2 pages
This is a legal document needed to confirm an applicant's eligibility for several assistance programs in Sarasota County, Florida to apply for and manage for benefits.
![AHCA MedServ Form 004 Part A1 "Preadmission Screen and Resident Review (Pasrr) Resident Review - Evaluation Request Form" - Florida](https://data.templateroller.com/pdf_docs_html/1729/17292/1729295/ahca-medserv-form-004-part-a1-preadmission-screen-and-resident-review-pasrr-resident-review-evaluation-request-form-florida.png "AHCA MedServ Form 004 Part A1 "Preadmission Screen and Resident Review (Pasrr) Resident Review - Evaluation Request Form" - Florida")
![Form DH-430 "Affidavit of Amendment of Certificate of Live Birth" - Florida](https://data.templateroller.com/pdf_docs_html/74/743/74355/form-dh-430-affidavit-amendment-certificate-live-birth-florida.png "Form DH-430 "Affidavit of Amendment of Certificate of Live Birth" - Florida")
![Form DH-MQA1030 "Physician Office Adverse Incident Report" - Florida](https://data.templateroller.com/pdf_docs_html/2214/22143/2214378/form-dh-mqa1030-physician-office-adverse-incident-report-florida.png "Form DH-MQA1030 "Physician Office Adverse Incident Report" - Florida")
![Form DH-MQA5002 "Osteopathic Physician Application for Temporary Certificate for Active Duty Military and Veterans Practicing in Areas of Critical Need" - Florida](https://data.templateroller.com/pdf_docs_html/2214/22143/2214379/form-dh-mqa5002-osteopathic-physician-application-for-temporary-certificate-for-active-duty-military-and-veterans-practicing-in-areas-of-critical-need-florida.png "Form DH-MQA5002 "Osteopathic Physician Application for Temporary Certificate for Active Duty Military and Veterans Practicing in Areas of Critical Need" - Florida")
![Form DH-MQA1031 "Office Surgery Registration Application" - Florida](https://data.templateroller.com/pdf_docs_html/2208/22084/2208443/form-dh-mqa1031-office-surgery-registration-application-florida.png "Form DH-MQA1031 "Office Surgery Registration Application" - Florida")
![Form DH2143 "Patient Information Request" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224751/form-dh2143-patient-information-request-florida.png "Form DH2143 "Patient Information Request" - Florida")
![Form DH3075 "Florida Wic Program Medical Referral Form" - Florida](https://data.templateroller.com/pdf_docs_html/328/3289/328977/form-dh-3075-florida-wic-program-medical-referral-form-florida.png "Form DH3075 "Florida Wic Program Medical Referral Form" - Florida")
![Form DH4157 "Pool Owner/Operator Verification of Entrapment Safety Features" - Florida](https://data.templateroller.com/pdf_docs_html/2244/22447/2244790/form-dh4157-pool-owner-operator-verification-of-entrapment-safety-features-florida.png "Form DH4157 "Pool Owner/Operator Verification of Entrapment Safety Features" - Florida")
![Form DH4159 "Application for a Swimming Pool Operating Permit" - Florida](https://data.templateroller.com/pdf_docs_html/2244/22447/2244788/form-dh4159-application-for-a-swimming-pool-operating-permit-florida.png "Form DH4159 "Application for a Swimming Pool Operating Permit" - Florida")
![Form DH3203 "Authorization to Disclosure Confidential Information" - Florida](https://data.templateroller.com/pdf_docs_html/570/5703/570385/form-dh-3203-authorization-to-disclosure-confidential-information-florida.png "Form DH3203 "Authorization to Disclosure Confidential Information" - Florida")
![Form DH1120 "Acceptable Use and Confidentiality Agreement" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224722/form-dh1120-acceptable-use-and-confidentiality-agreement-florida.png "Form DH1120 "Acceptable Use and Confidentiality Agreement" - Florida")
![Form DH3135 "Infant Risk Screen" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224727/form-dh3135-infant-risk-screen-florida.png "Form DH3135 "Infant Risk Screen" - Florida")
![Form DOH-MQA1014 "Financial Responsibility" - Florida](https://data.templateroller.com/pdf_docs_html/1728/17284/1728433/form-doh-mqa1014-financial-responsibility-florida.png "Form DOH-MQA1014 "Financial Responsibility" - Florida")
![Form DH5067 "911 Public Safety Telecommunicator Training Program Application" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224748/form-dh5067-911-public-safety-telecommunicator-training-program-application-florida.png "Form DH5067 "911 Public Safety Telecommunicator Training Program Application" - Florida")
![Form DH5066 "911 Public Safety Telecommunicator Initial/Original Certificate Application" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224744/form-dh5066-911-public-safety-telecommunicator-initial-original-certificate-application-florida.png "Form DH5066 "911 Public Safety Telecommunicator Initial/Original Certificate Application" - Florida")
![Form C-0039 "Staff Roster" - Pinellas County, Florida](https://data.templateroller.com/pdf_docs_html/294/2948/294891/form-c-0039-staff-roster-pinellas-county-florida.png "Form C-0039 "Staff Roster" - Pinellas County, Florida")
![Form DH4066 "Application for Maintenance Service Permit" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784167/form-dh-4066-application-maintenance-service-permit-florida.png "Form DH4066 "Application for Maintenance Service Permit" - Florida")
![Form DH1322 "Application for Radioactive Materials License" - Florida](https://data.templateroller.com/pdf_docs_html/73/732/73251/form-dh-1322-application-radioactive-materials-license-florida.png "Form DH1322 "Application for Radioactive Materials License" - Florida")
![Form DH4057 "Application for Variance From Chapter 64e-6, Fac" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784173/form-dh-4057-application-variance-from-chapter-64e-6-fac-florida.png "Form DH4057 "Application for Variance From Chapter 64e-6, Fac" - Florida")
![Form DH4015 "Onsite Sewage Treatment and Disposal System Existing System and System Repair Evaluation" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784152/form-dh-4015-onsite-sewage-treatment-and-disposal-system-existing-system-and-system-repair-evaluation-florida.png "Form DH4015 "Onsite Sewage Treatment and Disposal System Existing System and System Repair Evaluation" - Florida")
![Form DH4016 "System Repair Certification - Onsite Sewage Treatment and Disposal System" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784163/form-dh-4016-system-repair-certification-onsite-sewage-treatment-and-disposal-system-florida.png "Form DH4016 "System Repair Certification - Onsite Sewage Treatment and Disposal System" - Florida")
![Form DH4015 "Application for Construction Permit - Site Plan" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784148/form-dh-4015-application-construction-permit-site-plan-florida.png "Form DH4015 "Application for Construction Permit - Site Plan" - Florida")
![Form DH4015 "Onsite Sewage Treatment and Disposal System Application for Construction Permit" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784158/form-dh-4015-onsite-sewage-treatment-and-disposal-system-application-construction-permit-florida.png "Form DH4015 "Onsite Sewage Treatment and Disposal System Application for Construction Permit" - Florida")
![Form DH4015 "Site Evaluation and System Specifications - Onsite Sewage Treatment and Disposal System" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784160/form-dh-4015-site-evaluation-and-system-specifications-onsite-sewage-treatment-and-disposal-system-florida.png "Form DH4015 "Site Evaluation and System Specifications - Onsite Sewage Treatment and Disposal System" - Florida")
![Form DH1576 "Application for Air Ambulance Permit" - Florida](https://data.templateroller.com/pdf_docs_html/2076/20767/2076788/form-dh1576-application-for-air-ambulance-permit-florida.png "Form DH1576 "Application for Air Ambulance Permit" - Florida")
![Form DH4080 "Application for Variance From Chapter 64e-9, Florida Administrative Code - Swimming Pools and Bathing Places" - Florida](https://data.templateroller.com/pdf_docs_html/2244/22447/2244787/form-dh4080-application-for-variance-from-chapter-64e-9-florida-administrative-code-swimming-pools-and-bathing-places-florida.png "Form DH4080 "Application for Variance From Chapter 64e-9, Florida Administrative Code - Swimming Pools and Bathing Places" - Florida")
![Form DH3212 "Health Insurance Application for Extended Family Planning Benefits" - Florida](https://data.templateroller.com/pdf_docs_html/2049/20495/2049505/form-dh3212-health-insurance-application-for-extended-family-planning-benefits-florida.png "Form DH3212 "Health Insurance Application for Extended Family Planning Benefits" - Florida")
![Form DH4060 "Migrant Labor Camp or Residential Migrant Housing Inspection Report" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224777/form-dh4060-migrant-labor-camp-or-residential-migrant-housing-inspection-report-florida.png "Form DH4060 "Migrant Labor Camp or Residential Migrant Housing Inspection Report" - Florida")
![Form 1896 "Do Not Resuscitate Order" - Florida](https://data.templateroller.com/pdf_docs_html/1728/17283/1728339/form-1896-do-not-resuscitate-order-florida.png "Form 1896 "Do Not Resuscitate Order" - Florida")
![Form DH3202 "Domestic Violence Flow Sheet" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224715/form-dh3202-domestic-violence-flow-sheet-florida.png "Form DH3202 "Domestic Violence Flow Sheet" - Florida")
![Form DH4116 "Application for Septic Tank Contracting Course Provider" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784175/form-dh-4116-application-septic-tank-contracting-course-provider-florida.png "Form DH4116 "Application for Septic Tank Contracting Course Provider" - Florida")
![Form DH4115 "Application for Septic Tank Contracting Course Approval" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784176/form-dh-4115-application-septic-tank-contracting-course-approval-florida.png "Form DH4115 "Application for Septic Tank Contracting Course Approval" - Florida")
![Form DH4077 "Application for Certificate of Authorization" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784172/form-dh-4077-application-certificate-authorization-florida.png "Form DH4077 "Application for Certificate of Authorization" - Florida")
![Form DH4076 "Application for Septic Tank Contractor Registration Renewal" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784170/form-dh-4076-application-septic-tank-contractor-registration-renewal-florida.png "Form DH4076 "Application for Septic Tank Contractor Registration Renewal" - Florida")
![Form DH3146 "Citation for Violation Onsite Sewage Program/Sanitary Nuisance" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784166/form-dh-3146-citation-violation-onsite-sewage-program-sanitary-nuisance-florida.png "Form DH3146 "Citation for Violation Onsite Sewage Program/Sanitary Nuisance" - Florida")
![Form DH4120 "Application for Body Piercing Salon License" - Florida](https://data.templateroller.com/pdf_docs_html/2250/22501/2250119/form-dh4120-application-for-body-piercing-salon-license-florida.png "Form DH4120 "Application for Body Piercing Salon License" - Florida")
![Form DH3151 "Family Support Plan for Single Agency Care Coordination" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224717/form-dh3151-family-support-plan-for-single-agency-care-coordination-florida.png "Form DH3151 "Family Support Plan for Single Agency Care Coordination" - Florida")
![DH Form 4037 "Application for Mobile Home Park, Mobile Home Park Housing Migrant Farmworkers, Lodging Park, Recreational Vehicle Park and Recreational Camp" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224770/dh-form-4037-application-for-mobile-home-park-mobile-home-park-housing-migrant-farmworkers-lodging-park-recreational-vehicle-park-and-recreational-camp-florida.png "DH Form 4037 "Application for Mobile Home Park, Mobile Home Park Housing Migrant Farmworkers, Lodging Park, Recreational Vehicle Park and Recreational Camp" - Florida")
![Form DH4014 "Septic Tank Manufacture, Septic Tank Service and Temporary Privy Service Inspection Report" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784169/form-dh-4014-septic-tank-manufacture-septic-tank-service-and-temporary-privy-service-inspection-report-florida.png "Form DH4014 "Septic Tank Manufacture, Septic Tank Service and Temporary Privy Service Inspection Report" - Florida")
