Section R20-5-303. Forms Prescribed by the Commission

The Commission shall make the following forms, which contain the information listed, available upon request.

1.        Initial application for employment agent license:

a.        Name of candidate, including other names used by the candidate;

b.        Personal identifying information of candidate;

c.        Residence, length of residence, and place of prior residency of candidate;

d.        Employment history of candidate, including work history and experience as an employment agent;

e.        Personal references of candidate;

f.         Felony and misdemeanor convictions of candidate;

g.        Name, trade name, divisions and all other names under which candidate intends to do business;

h.        Proposed location of all business sites;

i.         Organizational structure of business;

j.         Names and addresses of all persons or firms having a financial interest in the business and the percent- age of financial interest of each person’s or firm’s share;

k.        Job classifications of proposed clientele;

l.         Fee rates and schedules of business;

m.      Names and addresses of all persons who will be involved in the management and supervision of the business at all locations of the business;

n.        Information  relating  to  Workers’  Compensation Insurance; and

o.        Request for education records; and

p.        Request for military discharge records.

2.        Business financial statement:

a.        Name of candidate;

b.        Business address of candidate; and

c.        Disclosure of financial information of candidate that pertains to financial stability or irregularity, misap- propriation, conversion, irregular withholding or accounting of money belonging to another person.

3.        Personal financial statement:

a.        Name of candidate or managing agent;

b.        Home address of candidate or managing agent; and

c.        Disclosure of personal financial information of can- didate or managing agent that pertains to financial stability or irregularity, misappropriation, conver- sion, irregular withholding or accounting of money belonging to another person.

4.        Supplemental application:

a.        Name  and  telephone  number  of  managing  agent, including other names used by the managing agent;

b.        Name of private employment agent with whom the managing agent intends to associate;

c.        Personal identifying information of managing agent;

d.        Residence, length of residence, and place of prior residency of managing agent;

e.        Employment history of managing agent, including work history and experience as an employment agent;

f.         Personal references of managing agent;

g.        Felony and misdemeanor convictions of managing agent; and

h.        Request for education records; and

i.         Request for military discharge records.

5.        Renewal application for employment agent license:

a.        Name, address, and telephone number of licensee seeking renewal;

b.        Position of licensee with employment agent busi- ness;

c.        Name, trade name, including abbreviations of name or trade name, of licensee seeking renewal;

d.        Current  legal  business   status  of  licensee  seeking renewal;

e.        Name of managing agent;

f.         Type of business to be renewed;

g.        Address of all business sites of licensee;

h.        Name of all divisions operated by licensee;

i.         Names and addresses of other businesses operated by licensee;

j.         Number  of  placement  counselors  employed  by licensee during preceding year;

k.        Schedule of fees and rules implemented by licensee and any changes in the schedule of fees and rules during the preceding year;

l.         List of changes made to forms required by A.R.S. § 23-521 et seq. and this Article in the preceding year;

m.      Information pertaining to complaints received in the preceding year by the licensee; and

n.        Information pertaining to compliance with the Ari- zona workers’ compensation laws.

Historical Note

Former Rule III; Amended effective March 9, 1981

(Supp. 81-2). R20-5-303 recodified from R4-13-303 (Supp. 95-1). Section R20-5-303 repealed; new Section R20-5-303 adopted effective September 9, 1998 (Supp.

98-3).