July 2024 Worker Occupational Safety and Health (WOSH) Specialist Training –  UC Berkeley training
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Email *
Dates of workshop you are registering for: *
REGISTRANT INFORMATION
Please ensure your first and last name (listed below) reflect how you would like them to appear on your Certificate of Completion.
First Name and Last name *
Preferred name (if different from above)
Email address *
Is this your work email? *
Direct phone number (xxx-xxx-xxxx) *
Is this your work phone number? *
WORK MAILING ADDRESS:
Note: if you are unemployed or retired, please write n/a for Employer and Work address
Name of Employer *
To which racial or ethnic group do you most identity? *
What language(s) do you speak at home? (check all that apply)
What are your preferred pronouns? *
What is your age? *
Which supplemental modules are you interested in? Please choose 2
 *
Required
EMPLOYMENT INFORMATION
What department do you work in? *
Job Title/Occupation *
What county do you work in? *
What is the main language(s) spoken at your workplace?
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