Fillable Employee Family Information (Colorado DORA)

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Employee Family Information (Colorado DORA)

On average this form takes 6 minutes to complete

The Employee Family Information (Colorado DORA) form is 1 page long and contains:

  • 1 signature
  • 5 check-boxes
  • 16 other fields

Country of origin: US
File type: PDF

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Colorado Department of Regulatory Agencies (DORA) is responsible for professional licensing and consumer protection in Colorado USA.

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Employee Family Information
City of Sterling Recreation Center / Logan County Shooting Complex
City of Sterling Full-Time Employee
or Elected Official
Logan County Full-Time Employee
or Elected Official
Employee: Spouse:
Phone Number: Phone Number:
Address:
Email Address:
Please list all dependents (must be immediate family members)
residing with you at your address.
Name: Name:
Name: Name:
Name: Name:
Employee Signature: Date:
Processed by: Date:
Processor's Title:
City of Sterling Recreation Center
Logan County Shooting Complex
Please select each facility that you and your family would like to access:
Will Not Use Either Facility
To Be Completed by Human Resources Office Only:
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Employee Family Information (Colorado DORA)

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Completed 25 January 2021

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