Multnomah County Health Dept. Food Handler Client Information Food Handler Certification Record Today’s Date / Fecha de hoy Month/Mes Day/Dia Year/Año Last Name / Apellidos completos First Name / Primer Nombre Middle Initial Date of Birth Fecha de Nacimiento Month/Mes Yes No Day/Dia Home / Código Postal Zip Code / de la Casa Year/Año Child Care Testing Food Handler testing for child care / Examen para el cuidado de niños Тест для работников детскиҳ садов Check the Education Level / Marque el Nivel de Educación Less than 6th Grade / Menos de 6 Grado Completed 6th Grade / Completó el 6 Grado (Primaria) Completed 12th Grade and above / Completó el 12 Grado o más 0-5 6 - 11 12 or above Test Language / Idioma del Examen Arabic / CD Video English Bosnian / CD Video Cambodian/ CD Video Cantonese Hindi / CD Video Japanese / CD Video Korean Laotian / CD Video Mandarin Russian Spanish / Español Tagalog / CD Video Thai / CD Video Vietnamese Specify Other Language: Do Not Write Below This Area / No escriba abajo de esta área. ÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆÆ Please review, ask client to complete any information not provided. Client # W CD PC FH Card # Dup Card # Location Food Handlers