HomeMy WebLinkAbout195332 03/16/2011 CITY OF CARMEL, INDIANA VENDOR: 00350816 Page 1 of 1
ONE CIVIC SQUARE PAUL ARNONE CHECK AMOUNT: $75.00
CARMEL, INDIANA 46032 IN
CHECK NUMBER: 195332
CHECK DATE: 311612011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMO UNT DESCRIPTION
651 5023990 75.00 EMPLOYEE PENSIONS B
APPLICATION FOR VOLUNTARY
COLLECTION SYSTEM
OPERATION CERTIFICATION
Administered by the Indiana Water Environment Association's Collection System ic±::!��
NO complete application f is required, includin a $65.00 (non refundable) application fee for class 1 II examination and $75 .00 (non
refundable app lication ee for class 11] lV examinations detailed employment information; supervisor's and ap plicant's si gnaatrres and verificati f
your post high school educational qualifications attached. The application is to be typed, or neatly printed. pu �!uhl ailure to
return a completed application form by the final filing date will result in your ineligibility for that examination and forfeiture of your application fee. ALL
EDUCATIONAND EXPERIENCE REQUIREMENTS MUST BE METAND CLEARLY STATED. FAILURE TO MEET OR VERIFY EITHER OF
THESE WILL RESULT IN INELIGIBILTY FOR THE EXAMINATION.
All applications must be received prior to the 2nd Thursday in March for the April Examination and the 2ndThursday in September for the October
Examination
CERTIFICATION EXAMINATION APPLICATION, CLASS: CS CS -1I CS C' CS IV (CIRCLE ONE)
DATE: 3
1. APPLICANT INFORMATION ,11 w��^ PAU A. NAME A_VVntve L I
Last �L�J� Aje yV S.1 I Middle
B. MAILING ADDRESS r
t f?, Street TO 7 (D D 3- U1 A
City State Zip Code County
C. WORK PHONE NUMBER: 10� HOME PHONE NUMBER: (3 -i_ S 4:0 o 1 31
Area Code Number Area Code Number
D. E-mail Address: Po r n0 Y\ e_ e Cary" e t g o J
E. What is the preferred way of contacting you? (Certifications will still be sent to mailing address. All other correspondence will occur by
your preference) CIRCLE ONE
Mailing Address E -mail Address
F. Have you previously applied for a Collection System Certificate? YES NO (CIRCLE ONE)
G. What certifications do you presently hold? List all that apply:
Certification Number State Grade (Class)
Water Treatment
Water Distribution
Municipal Wastewater Treatment
Industrial Wastewater Treatment
Wastewater Collection System r d CS
Other
II. EDUCATION AND TRAINING i
A. High School: Name of School: Cl A �G y I. S ,�J Location: CC," VIA y
Years Attended: O U 'S Date of Graduation: M
B. College: Name of School: Location:
Years Attended: Date of Graduation:
C. NOTE: Attach verification of your post -hieh school educational qualifications. Copies of college transcripts or certificates of
completion for courses related to wastewater treatmenticollection provide acceptable proof of educational qualifications. You may
list training courses, short courses, or other courses in the wastewater field that you have attended on Page 4. Include only post high
school information
APPLICATION FOR VOLUNTARY
COLLECTION SYSTEM
OPERATION CERTIFICATION
Administered by the Indiana Water Environment Association's Collection System Committee
NOTE: A complete application form is required including a $65.00 (non refundable) application fee for class 1& II examinations and $75.00 (non
refundable) application fee for class III IV examinations; detailed employment information; supervisor's and applicant's signatures; and verification of
your post high school educational qualifications attached. The application is to be typed, or neatly printed. Checks shall be payable to IWEA. Failure to
return a completed application form by the final filing date will result in your ineligibility for that examination and forfeiture ofyour application fee. ALL
EDUCATIONAND EXPERIENCE REQUIREMENTSMUST BE METAND CLEA.RLYSTATED. FAILURE TOMEET OR VERIFYEITHER OF
THESE WILL RESULT IN INELIGIBIL TY FOR THE EXAMINATION.
All applications must be received prior to the 2nd Thursday in March for the April Examination and the 2ndThursday in September for the October
Examination.
CERTIFICATION EXAMINATION APPLICATION, CLASS: CS CS 11 QS-19 CS -IV (CIRCLE ONE)
DATE: 3 7 1 1
I. APPLICANT INFORMATION
A. NAME YVi f`l Nl 1� as 11
B. MAILING ADDRESS 71. &59'/749 4 42 1
PAUL ARNONE 11
Cra
rrnel JANET R. ARNONE
City 1231. HILLCREST DRIVE DATE r
CARMEL IN 46033
C. WORK PHONE NUMBER:
PAY TO TFIE �-s
I ORDER OF
.rWv pp,
D. E -mail Address: �rr,�S DOLLARS IJ
C� r j E:i d P t f.`.:.%t;
E. What is the preferred way of ci I
7 NP
MAN CS eS
MEMO
F. Have you previously applied fa h 1' I+ 2.1
G. What certifications do you Ares____,
Certification Number State Grade (Class)
Water Treatment
Water Distribution
Municipal Wastewater Treatment
Industrial Wastewater Treatment e
Wastewater Collection System d J
Other
II. EDUCATION AND TRAINING �yy /1
A. High School: Name of School: l0 1'11q �j f �,pQ� Location: C C. {nne.1
Years Attended: $_1 W �j Date of Graduation: Aa 1%S
B. College: Name of School: Location:
Years Attended: Date of Graduation:
C. NOTE: Attach verification of your post -high school educational qualifications. Copies of college transcripts or certificates of
completion for courses related to wastewater treatment/collection provide acceptable proof of educational qualifications. You may
list training courses, short courses, or other courses in the wastewater field that you have attended on Page 4. Include only post high
school information
VOUCHER 107290 WARRANT ALLOWED
T1043 IN SUM OF
ARNONE, PAUL
CARMEL UTILITIES
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
f
Board members
PO INV ACCT AMOUNT Audit Trail Code
031411 01- 7040 -01 $75.00
Voucher Total $75.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T1043
ARNONE, PAUL Purchase Order No.
CARMEL UTILITIES Terms
Due {Gate 3/10/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/10/2011 031411 $75.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer