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Form Tobacco Use Affidavit

  • Size: 1367 KB
  • Author: none
  • Creation time: Tue Oct 2 14:27:40 2014
  • Pages: 8

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Pages: 8
Form Tobacco Use Affidavit

Tobacco Use Affidavit This Form is used to determine eligibility for the July 1 2014 Tobacco Surcharge If you are notcovered under the College s medical plan you do not need to complete this Form but will need tocomplete the attached Health Benefits Election Form Failure to return the Tobacco Use Affidavitwill result in the Tobacco Surcharge being applied to the employee s medical premiumTobacco U...

  • Author: none
  • Size: 466 KB
  • Creation time: Mon Jun 30 15:25:38 2014
Pages: 8
Tobacco Surcharge Affidavit

Tobacco Cessation Affidavit Employees who have identified that one or more enrolled family members in a Flextronics-sponsored medical plan are Tobacco usersand therefore required to pay a monthly Tobacco Surcharge of 50 for 1 Single Tobacco User or 100 for 2 or more Tobacco Usersper familyThis Affidavit certifies that employee or enrolled dependent named below have been Tobacco Free for a minimum ...

stellarmicro.com/oe13/documents/Tobacco Surcharge Affid...e Affidavit.pdf
  • Author: none
  • Size: 105 KB
  • Creation time: Fri Oct 26 17:33:27 2012
Pages: 8
Tobacco Use Survey Summary

Tobacco Use Survey Brief description of project The Tobacco Control Survey encompassed a needs assessmentconcerning Tobacco Use behaviors on campus among students staff and faculty such as frequencytobacco product preference and quitting attempts Included were additional policy questions aboutlevels of interest towards a Tobacco-free campus Finally we also built-in demographic questionsrelating to...

studentaffairs.utah.edu/assessment/documents/assessment...y - Summary.pdf
  • Author: none
  • Size: 88 KB
  • Creation time: Thu Feb 16 13:07:34 2012
Pages: 8
Rfp Tobacco Use Prevention

Microsoft Word - RFP - Tobacco-Use Prevention.doc The Children s Health InitiativeRequest for Proposals forYouth Tobacco Use Prevention Programsin 2008October 1 2007Section I BACKGROUNDThe Dutchess County Children s Services Council a partnership of Dutchess County governmentUnited Way of Dutchess County not-for-profit organizations and individuals representingcommunity constituencies is pleased t...

mhadc.com/csc_web/httpdocs/RFP - Tobacco-Use Prevention... Prevention.pdf
  • Author: none
  • Size: 200 KB
  • Creation time: Mon Oct 22 13:35:47 2007
Pages: 8
Aetc Public Affairs Tobacco Use Terminated In Technical Trai

Tobacco Use terminated in technical training Tobacco Use terminated in technicaltrainingby 1st Lt Elaine M LarsonAir Education and Training Command Public Affairs6 21 2004 - RANDOLPH AIR FORCE BASE TexasAFPN Tobacco Use and possession are no longer allowed for nonprior-service technical trainingstudents at any time while on base or in uniformThe change is included in Air Education and Training Com...

ndri.org/ctrs/ibhr/docs/AETC Public Affairs Tobacco Use...hnical Trai.pdf
  • Author: none
  • Size: 22 KB
  • Creation time: Mon Jan 16 14:12:53 2006