Barber Apprentice Application Form – Fill Out and Use This PDF

APPLICATION FOR FOUR-YEAR APPRENTICE LICENSE

GEORGIA STATE BOARD OF COSMETOLOGY AND BARBERS 237 Coliseum Drive • Macon, Georgia 31217 • (478) 207-2440

www.sos.ga.gov/plb/cosmetology

Please read the instructions carefully and be familiar with the laws and rules governing the practice of

Cosmetology/Barbers/Hair Designer/Nail Technology/Esthetics in the State of Georgia.

Visit our website for information: www.sos.ga.gov/plb/cosmetology

*** IMPORTANT ***

The Board CANNOT process incomplete applications. If ANY item is missing, incomplete, or incorrect, your application cannot be reviewed by the Board. Please review this application before you submit it to ensure that all information and documentation is complete and correct. Incomplete applications result in delayed processing. Incomplete applications are void after one year. Furthermore, because application information is time sensitive, documents cannot be transferred from an old application to a new application.

APPLICATION CHECKLIST

The following checklist is an important part of your application. Please use this checklist to ensure that you submit a COMPLETE application. We recommend you keep a copy of your application for your records.

฀NON-REFUNDABLE 4-YEAR APPRENTICE APPLICATION FEE: $90

CHANGE OF SHOP / MASTER OR CURRENT 2-YR APPRENTICE RENEWAL: $90

You must include a $90 check or money order payable to the Georgia State Board of Cosmetology and Barbers. DO NOT SEND CASH OR COUNTER CHECKS. Checks returned for insufficient funds are subject to a $30.00 service charge pursuant to O.C.G.A. § 16-9-20.

฀CITIZENSHIP/QUALIFIED ALIEN STATUS: Submit a copy of your current Secure and Verifiable Document(s) such as driver’s license, passport, or document as indicated on pages 3 and 4.

฀NOTARIZED APPLICATION: The complete application must be mailed to the Board’s office at the address listed above, along with your FEE. Sign the application in the presence of a notary.

฀SUBMIT APPLICATION IN A 9X12 or LARGER ENVELOPE – – DO NOT STAPLE pages or check/money order. Do not fold pages of the application. Make check/money order payable to Georgia State Board of Cosmetology and Barbers submit to 237 Coliseum Drive, Macon, GA 31217. We recommend using US Mail or private courier (UPS, FedEx, etc.) with tracking. Keep a copy of your application for your records.

DO NOT SUBMIT THIS PAGE WITH YOUR APPLICATION

INSTRUCTIONS FOR THE COSMETOLOGY/ BARBER APPRENTICE APPLICATION

Failing to follow these instructions will delay the processing of your application

Section 1 This section is to be completed by the applicant, signed and notarized.

Section 2: This section is to be completed by the master licensee who will supervise the apprentice. This section must be signed and notarized. The signature of the master trainer must be legible or the application will be returned. The signature of the master trainer must be signed as it appears on the license.

Failure to do so will result in the application being returned and delay processing your application.

APPRENTICE REQUIREMENTS:

1.Cosmetology Apprentice training is on-the-job training in a salon/shop and under the direct supervision of a licensed master licensee with at least 36 months’ experience. Barber Apprentice training is on-the-job training in a salon/shop and under the direct supervision of a licensed master barber with at least 18 months’ experience.

2.Each master barber, cosmetologist, esthetician, hair designer, or nail technician licensee in a salon/shop may train only one (1) apprentice at a time.

3.Any person at least 16 years of age may qualify to train as an apprentice.

4.Apprentice hours are accumulated according to the actual number of hours of performance and training. Apprentice hours are subtotaled 1st of January, the 1st of April, and the 1st of September. Hours reported will be kept on file by the salon/shop owner or manager for inspector review.

The salon/shop owner and master level trainer are responsible for submitting the apprentice hours after the apprentice has completed the hours or is no longer apprenticing under the current master level

trainer.

5.Upon completion of the required hours within the appropriate minimum months of training, it is the apprentice’s responsibility to obtain and submit an application for examination and or licensure. Examinations will be administered only by PSI. Contact PSI about the examinations, fees, dates, locations, exam content and grade notifications using one of the following:

Online 24/7 at www.psiexams.com or by phone 24/7 at (800) 733-9267.

PSI Registrar at (800) 733-9267 Monday-Friday 7:30 a.m.-8:00 p.m., Saturday 11:00 a.m. -5:00 p.m. EST.

CREDIT FOR TRAINING HOURS BEGINS WHEN THE APPRENTICE LICENSE IS ISSUED,

NOT WHEN THE APPLICATION IS MAILED TO THE BOARD OFFICE.

APPRENTICE TRAINING:

1.The apprentice will receive a certificate of registration for a period of four (4) years. THERE ARE NO RENEWALS OF THE 4-YEAR APPRENTICE LICENSE; only a current 2-year Apprentice may renew for $90. If the apprentice is changing a master, or salon/shop location, or if the salon/shop where the apprentice is working has a change in its license status, the apprentice must submit a new application with the salon/shop change.

2.Upon the expiration of the last certificate of registration issued, such apprentice shall not be permitted to practice the occupation in any way until he or she obtains his or her license.

3.Hours can only be obtained during the period of time that the apprentice is licensed.

CHANGE OF TRAINING:

If any of the following occurs during the apprenticeship, a new apprentice application must be filed with the Board office and a fee of $90.00 must be submitted with the application – NO EXCEPTIONS:

Change of Master supervising the apprentice; or

Apprentice changes to a new salon; or

If the salon where you are apprenticing changes name, location or ownership causing a new salon license number to be issued.

COSMETOLOGY APPRENTICESHIP HOURS REQUIRED FOR EXAMINATION:

฀ COSMETOLOGY APPRENTICE ฀ NAIL TECHNICIAN APPRENTICE

Please check the appropriate box:

฀Initial Application $90 ฀ ChangeofShop/Master or 2yr Renewal $90

ALL Licenses currently or previously held issued to you by the Georgia Professional Licensing Boards:

__________________________________________________________________________________

1.Legal Name to appear on License:

2. Name as shown on exam records, transcripts or any documentation provided to the Board including maiden name (if different):

_____________________________________________________________________________________________________

¹This information is authorized to be obtained & disclosed to state & federal agencies pursuant to O.C.G.A. § 19-11-1 & O.C.G.A. § 20-3-295, 42 U.S.C.A. § 551 & 20 U.S.C.A. § 101.

6.Mailing 2 Address:

(P.O. BOX ACCEPTABLE )2 O.C.G.A. §43-1-2 (k) Your name, mailing address and license number are public information and will appear on Secretary of State’s website

8. E-mail Address 3: (Please print clearly)___________________________________________________________________________________________

3Acknowledgement of your application will be sent to your email. If further information is needed, Board staff will contact you by email so that your application can be processed in the most efficient manner. Your email will not be shared with third parties.

Please check this box if you are a military spouse or a transitioning service member of the United States armed forces (including the National Guard).

SECTION 1 – TO BE COMPLETED BY COSMETOLOGY OR BARBER APPRENTICE APPLICANT

This application will be returned if you do not answer the questions on this page.

Print Your Name: _______________________________________________________

Have you ever been arrested or convicted of a felony, misdemeanor (other than a minor traffic violation), crime involving moral

turpitude, or a crime violating federal or state law relating to controlled substances or dangerous drugs? (DWI and DUI are not minor traffic violations.) For purposes of this question, a “conviction” includes a finding of verdict of guilty, plea of guilty, a plea of nolo

contendere, or first offender treatment, and also includes adjudication of guilt or sentence withheld or not entered on the charge (s).

NOTE: The answer to this question is “YES” if an arrest or conviction has been pardoned, expunged, dismissed or deferred, you pled & completed probation under First offender and/or your civil rights have been restored and/or you have received legal advice that the offense will not appear on your criminal record.

 NoYes 

If you answered “Yes” to the question regarding arrest/court convictions, you must submit the following to the Board:

(a)Submit a letter of explanation and certified copy of final court disposition from the county(s) in w h i c h you were arrested/convicted. The court document should include the charges and sentencing information.

(b)Probation/Parole - Submit a statement (on official letterhead) from your probation / parole officer regarding your current status. If probation/parole has been completed, submit certified documents from the courts verifying case closed and completion of probation / parole.

If you answered “Yes” regarding sanctions from another board, you must request that the licensing board or

agency send a certified copy of the action taken against your license with relevant supporting documents to the Board’s office. Your application will not be processed until this information is received and reviewed by

the Board. Provide the name of the agency or board in the space provided:

___________________________________________________________

NOTARIZED SIGNATURE BY COSMETOLOGY AND BARBER APPRENTICE APPLICANT

APPLICANT AFFIDAVIT

I hereby swear and affirm that all information provided in this application is true and correct to the best of my knowledge and belief. I further swear and affirm that I have read and understand the current state laws and rules and regulations of the Georgia State Board of Cosmetology and Barbers and I agree to abide by these laws and rules, as amended from time to time.

By signing this application, electronically or otherwise, I hereby swear and affirm one of the following to be true and accurate (Check or initial beside #1 or #2 below):

1)_______ I am a United States citizen least 18 years of age or older. You must submit a copy of your current photo ID or

Secure and Verifiable Document(s) such as driver’s license, passport, or other document.

2)_______ I am not a United States citizen, but I am a legal permanent resident of the United States 18 years of age or older, or I

am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years of age or older with an alien number issued by the Department of Homeland Security or other federal immigration agency. You must submit a

copy of your current immigration document(s) which includes either your Alien number or your I-94 number and, if needed, SEVIS number. When submitting a “green card,” please provide a copy of the front and back of

the card.

The undersigned applicant also hereby verifies that he or she is at least 18 years of age or older and has enclosed at least one form of acceptable identification such as a Secure and Verifiable Document as required by O.C.G.A. § 50-36-1(e)(1), with this Affidavit.

In making the above representations under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. I also understand that any failure to make full and accurate disclosures may result in disciplinary action by the Board for which I am applying for licensure.

Print Name of Applicant

Signature of Applicant

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE O.C.G.A. § 45-17-6 requires legible seals for notarized documents. If an embossed seal is used a foil overlay or shading should be applied to make the seal, state, title, name, and county legible when digitized.

SECTION 2 – TO BE COMPLETED BY MASTER

Apprentice Name: _______________________________________________________________

Salon/Shop Name:____________________________________ License No._________________

(for this application)

Physical Address of Salon/Shop:____________________________________________________

(Including Suite and/or Studio #)

Supervisor Name: _____________________________ License No. ______________________

(for this application)

Questions for the Master Supervising the Apprentice Barber, Barber II, Cosmetologist, Hair Designer, Esthetician or Nail Technician:

Yes No Salon/Shop owner or manager or master trainer, are responsible for keeping daily record of apprentice hours.

Yes No Salon/Shop owner or manager and master trainer are responsible for apprentice having a thorough understanding of sanitization. Refer to sanitation tip sheet.

Yes No Master trainer always monitors apprentice’s sanitation procedure.

Yes No Do you have cosmetology and/or barber books/workbook for apprentice to study?

Yes No Do you have the sanitary regulations for apprentice to study?

Yes No Do you have the rules of the Georgia State Board of Cosmetology and Barbers for Apprentice to study?

Yes No Does Apprentice have related kit, and all the tools they will need to learn the specific profession in cosmetology or barbering?

Yes No I understand the following regarding apprentices:

Hours can only be obtained during the period of time that the apprentice is licensed. If an apprentice changes master supervisor or salon/shop where he/she is apprenticing, a new apprentice application must be submitted. If the salon/shop changes ownership, name or location causing a new license number to be issued, a new apprentice application must be submitted. Hours can only be obtained during the period of time that the apprentice, master and salon license are active.

Yes No I UNDERSTAND: APPRENTICE HOURS ARE SUBTOTALED 1ST OF JANUARY, 1ST OF APRIL, AND 1ST OF SEPTEMBER.

Yes No I UNDERSTAND: HOURS REPORTED WILL BE KEPT ON FILE BY SALON/SHOP OWNER OR MANAGER FOR INSPECTOR TO REVIEW.

SECTION 2 CONTINUED ON NEXT PAGE

SECTION 2 CONTINUED – TO BE COMPLETED BY MASTER

Yes  No I UNDERSTAND: Failure to have apprentice reports and/or records current shall result in a Fine of $25.00 for 1st offense; $75.00 for 2nd offense; $300.00 for any subsequent offense (Rule 240-2-.02).

Yes  No I UNDERSTAND: Failure of apprentice to be under direct supervision of their registered master license holder or temporarily designated master license holder shall result in a Fine of $25.00 for 1st offense; $75.00 for 2nd offense; $300.00 for any subsequent offense (Rule 240-2-.02).

Yes  No I UNDERSTAND: Apprentice hours are accumulated according to the actual number of hours of performance and training. It is the responsibility of the salon/shop owner and the master to see that an accurate record is kept of the apprentice hours. IT IS NOT THE RESPONSIBILITY OF THE APPRENTICE.

Yes  No I UNDERSTAND: IT IS MY RESPONSIBILITY AS MASTER TO SUBMIT APPRENTICE HOURS AT THE END OF THE APPRENTICESHIP EVEN IF THE APPRENTICE IS NO LONGER TRAINING WITH ME FOR ANY REASON.

I agree to act as supervising master barber, master cosmetologist, nail technician, esthetician or hair designer for the apprentice whose name appears above. I agree to provide direct supervision when the apprentice whose name appears above is working in the salon/shop.

It is hereby certified that_____________________________________________________________________________

Salon/Shop Name ________________________________________ Salon/Shop License No._______________________

Completed the following hours from _____________________________ to _____________________________________

MM/DD/YYYYMM/DD/YYYY

Master Signature ______________________________________ Master License No. ____________________________

Apprentice Signature_________________________________________________________________________________

Hours can only be obtained during the period of time that the apprentice is licensed. If an apprentice changes master superv isor or salon/shop where he/she is apprenticing, a new apprentice application must be submitted. If the salon/shop changes ownership, name or location causing a new license number to be issued, a new apprentice application must be submitted. Hours can only be obtain ed during the period of time that the apprentice, master and salon/shop license are active.

It is hereby certified that_________________________________________________________________________

Salon/Shop Name ________________________________________ Salon/Shop License No.__________________

Completed the following hours from _____________________________ to ________________________________

MM/DD/YYYYMM/DD/YYYY

Master Signature ______________________________________ Master License No. _______________________

Apprentice Signature____________________________________________________________________________

Hours can only be obtained during the period of time that the apprentice is licensed. If an apprentice changes master superv isor or salon/shop where he/she is apprenticing, a new apprentice application must be submitted. If the salon/shop changes ownership, name or location causing a new license number to be issued, a new apprentice application must be submitted. Hours can only be obtain ed during the period of time that the apprentice, master and salon/shop license are active.

It is hereby certified that___________________________________________________________________________

Salon/Shop Name ________________________________________ Salon/Shop License No.____________________

Completed the following hours from _____________________________ to __________________________________

MM/DD/YYYYMM/DD/YYYY

Master Signature ______________________________________ Master License No. _________________________

Apprentice Signature______________________________________________________________________________

Hours can only be obtained during the period of time that the apprentice is licensed. If an apprentice changes master supervisor or salon where he/she is apprenticing, a new apprentice application must be submitted. If the salon changes ownership, name or location causing a new license number to be issued, a new apprentice application must be submitted. Hours can only be obtained during the perio d of time that the apprentice, master and salon license are active.