Locksmith Application, Page 4
I HAVE ENCLOSED: (***Required for Processing***)
Two (2) color passport-style photos: (with your name and Social Security Number printed on the back of each)
Place the photos in a small envelope with your name printed on it and attach to the application.
Two (2) completed fingerprint cards or copy of your receipt for electronically scanned prints: Prints must be rolled nail to nail by a qualified, trained technician on the fingerprint cards provided by this office. The cards must be fully completed and signed. All questions in the blocks at the top of the card must be answered. Enter N/A if the question does not apply to you.
Final Court dispositions (judgements) on any and all charges/arrests.
Proof of a total of thirty (30) Hrs of basic education and an additional eight (8) Hrs for each category.
Proof of forty (40) Hrs experience in general locksmithing and an additional ten (10) Hrs for each category.
Proof of a valid business license for each business entity for the county and city in which the business is located,
or proof of employment by an association, corporation, partnership, institution, or government agency exempt from paying privilege taxes under title 67, chapter 4 and a notarized statement that no locksmithing services are being offered directly to the public;
General Liability Insurance: Attach a current Certificate of Insurance as evidence of coverage.
Examination: You are responsible for scheduling the required examination and must successfully complete the required examination prior to issuance of your license. Please refer to the Examination Candidate Information Brochure regarding scheduling and reference materials.
If you can provide satisfactory documentation of five (5) years of full-time locksmithing experience as of June 25, 2007, you will not be required to sit for the examination.
Please refer to Tenn. Code Ann. § 62-11-111(a)(6) regarding acceptable documentation of experience.
Locksmith Company Application: All locksmiths required to be licensed in Tennessee must also apply for or be employed by a Registered Locksmith Company. Please refer to Administrative Rule 0780-5-13-.03(d), and the Locksmith Company Application for additional information.
STATEMENT OF COMPLIANCE AND UNDERSTANDING:
NOTICE, AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT
I, the undersigned applicant, do hereby authorize the Tennessee Department of Commerce and Insurance, Division of Regulatory Boards, Locksmith Licensing Program to procure a consumer report and/or investigative consumer report on me. I understand that this authorization and release shall be valid for subsequent consumer and/or investigative consumer reports during my period of certification, licensure or registration by this agency for the purpose of investigating my credit references, and any workplace misconduct or criminal activity for which I am alleged to have been involved in.
These above-mentioned reports may include, but are not limited to, information as to my character, general reputation, and personal characteristics, discerned through employment and education verifications, personal references, personal interviews, my personal credit history based on reports from any credit bureau; my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; any other public record.
I further authorize any person, business entity or governmental agency who may have information relevant to the above to disclose the same to the Tennessee Department of Commerce and Insurance, including but not limited to any and all courts, public agencies, law enforcement agencies and credit bureaus, regardless of whether such person, business entity or governmental agency compiled the information itself or received it from other sources.
I understand that any false statement(s) and/or misrepresentations(s) given by me on this application or on any attachments will be punishable under Tenn. Code Ann. § 62-11. Therefore, I certify that all answers, statements, and information given herein and on any attachments, are true and correct to the best of my knowledge and belief.
_____________________________________________ (Applicant Signature)
_________________________ (Date Signed)