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Get Occ 1204 2019-2024

Ddress of Child Care Applicant/Provider/Facility: Initial Employment Biennial (Two Year Update) Other E. PLEASE READ: This person to be evaluated either provides or plans to provide child care services, lives in a home where child care is provided or will be provided. The Medical Evaluation is to assess this individual s ability to perform the following Child Care Activities: Lifting, carrying children (infants, toddlers, preschool and school age) Desk work, reading & writ.

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