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
If you have additional documents to send, please email them to eh@tooelehealth.org.
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:
 Change Payment Method
 
Submitting ...
CORE Payments © 2024 CORE Business Technologies. All rights reserved.
~ Our Solutions ~ Privacy Policy ~ Contact Us ~
CORE Payments Version 4.1.17016; (API: 2.22)
RSI Security