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Please keep a copy of this form and the certificate of completion for your records. Originals will not be returned. TOBACCO CESSATION AFFIDAVIT If you or your spouse use tobacco, and you want to qualify
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Start by providing your personal details such as your full name, date of birth, and contact information. This helps to identify you accurately.
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Next, include your current address, including the street, city, state, and zip code. This information is crucial for correspondence purposes.
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Proceed to provide your educational background, starting with the most recent institution attended. Include the years of attendance, degree earned, and any relevant certifications or honors.
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If applicable, include your employment history. Start with your current or most recent job, providing the job title, company name, employment dates, and a brief description of your responsibilities.
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Section A information is about providing details related to a specific topic or category.
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Section A information typically requires reporting of specific data or details as specified by the governing body.
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