Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444

Application For Food Safety Manager Certification

Please put N/A for any fields that are not applicable

Applicant Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:

Place of Employment
Date of Birth

Read and Sign
I agree to abide by all local ordinances and laws of the State of Utah governing the service of food and beverageand I understand that failure to do so may result in revocation of my Food Safety Manager Certification.
Signature
Date

Name of Food Service Manager Exam
Date of Exam

Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
 
Submitting ...
SIP Program & Data © 2006-2020 Instant Payments All rights reserved.
~ Terms & Conditions ~ Privacy Policy ~ Contact Us ~
SIP Version 3.05.13176; (API: 2.17)
RSI Security PCI DSS Compliance Instant Payments BBB Business Review