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Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435) 277-2444
www.tooelehealth.org
Application For Food Handler Permit
Please put N/A for any fields that are not applicable
Applicant's Information
First Name:
Last Name:
Address:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:
Email:
Date of Birth
Phone Number
Place of Employment
If you have additional documents to send, please email them to
eh@tooeleco.gov.
I agree to abide by all local ordinances and laws of the State of Utah governing the service of food and beverage and I understand that failure to do so may result in revocation of my food service worker’s permit and/or other action as the law req
Signature of Applicant
Date
Food Handler Permit:
$20.00
Select:
Item Subtotal:
$0.00
Food Handler Re-Issue (for lost permits):
$5.00
Select:
Item Subtotal:
$0.00
Total:
$0.00
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Payment Information:
Method of Payment:
Credit/Debit Card
eCheck
Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
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First Name: is required
Last Name: is required
Address: is required
City: is required
State/Province: is required
ZIP/Postal Code: is required
Phone: is required
Email: is required
Date of Birth
is required
Phone Number
is required
Place of Employment
is required
Signature of Applicant
is required
Date
is required
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