The California Form Rehs 02 is used to report the names, addresses, and Social Security numbers of any household members who are not exempt from required filings. This form must be filed by all employers in California with one or more employees, regardless of whether they are hired through a temporary help agency or not. The deadline for filing this form is typically on or before January 31st of each year. Make sure to familiarize yourself with the specific requirements and deadlines related to this form so that you can file it correctly and on time.
| Question | Answer |
|---|---|
| Form Name | California Form Rehs 02 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names |
State of California – Health and Human Services Agency |
California Department of Public Health |
REGISTERED ENVIRONMENTAL HEALTH SPECIALIST - Continuing Education Verification Form
INSTRUCTIONS: Complete section below to verify completion of 24 contact hours of Registered Environmental Health Specialist (REHS) continuing education. If necessary continue on a separate sheet of paper.
DO NOT SEND ORIGINAL CERTIFICATES OR COPIES UNLESS INSTRUCTED BY THIS OFFICE. Copies of your certificates will be required to document course completion by the Environmental Health Specialist (EHS) Registration Program during the audit process. If you are selected for an audit, you will be notified by email. You must sign the signature line at the bottom of this form to certify the authenticity of your reported continuing education courses.
Send this completed form along with your renewal application and payment to: |
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California Department of Public Health |
Name: ______________________________________________________ |
EHS Registration Program MS 7404 |
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PO Box 997377 |
REHS #: _________________________ |
Sacramento, California |
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Date of |
Course |
Contact Hours |
Received |
Course Title
Recognized Provider/
Instructor
Accreditation Agency
Location
TOTAL HOURS =
I certify that I have taken the courses listed above and will have certificates in my possession to verify successful completion of the continuing education courses listed. I understand that I am responsible for maintaining these legal documents for five years.
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Signature ___________________________________________________________________ |
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Date ___________________________________________ |
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FOR EHS REGISTRATION PROGRAM USE ONLY: |
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REHS CE Hours Complete |
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Need Further Review |
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Selected for Random Audit |
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REHS 02 (6/12)