APPLICATION FOR
COSMETOLOGY APPRENTICE
GEORGIA STATE BOARD OF COSMETOLOGY
237 Coliseum Drive
Macon, Georgia 31217
Phone (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 in the State of Georgia. Visit the 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 old applications to new applications.
Application Checklist
The following checklist is an important part of your application. Please use this checklist to ensure that you submit a COMPLETE application.
NON-REFUNDABLE APPLICATION FEE: $45 – Cosmetology Apprentice
The payment must be made by check or money order payable to the Georgia State Board of Cosmetology. DO NOT SEND CASH OR COUNTER CHECKS. Checks returned for insufficient funds are subject to a $40.00 service charge pursuant to O.C. G.A. § 16-9-20.
CITIZENSHIP/QUALIFIED ALIEN STATUS: Please submit a copy of your current Secure and
Verifiable Document(s) such as driver’s license, passport, or document as indicated on pages 22 & 23 of this application.
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.
Copy of current shop license and master license are attached
Letter from master releasing previous apprentice (if applicable)
If the master under whom you are training has previously trained an apprentice, our records must indicate that they are no longer training that person. If a master has not notified us that he or she is no longer training an apprentice, he or she must notify us in writing. Without this notification, your application will be delayed.
SUBMIT APPLICATION IN A 9X12 or LARGER ENVELOPE – Do not staple pages or check/money order. Do not fold pages of the application.
Revision Date July 2012 |
1 |
INSTRUCTIONS FOR THE COSMETOLOGY APPRENTICE APPLICATION
Please read the instructions carefully and be familiar with the Laws and Rules governing the specific area in which you are seeking licensure. Failing to follow these instructions will delay the processing of your application.
Section 1 & 2: This section is to be completed by the applicant, signed and notarized.
Section 3: 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 will cause delay in the processing of the apprentice license.
APPRENTICE REQUIREMENTS:
1.Apprentice training is on-the-job training in a cosmetology salon/shop and under the direct supervision of a licensed master licensee with at least 36 months’ experience.
2.Each master cosmetologist or esthetician, nail technician licensee in a salon/shop may train only one (1) apprentice at a time.
3.Any person at least 17 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. The Master Cosmetologist, Esthetician, Nail Technician and Instructors examinations will be administered only by PSI. You may contact PSI using one of the following:
Via the Internet 24 hours a day at www.psiexams.com.
Using a touch-tone phone, call PSI 24 hours a day at (800) 733-9267.
With a PSI registrar at (800) 733-9267, available Monday through Friday, between 7:30 am and 8:00 pm and Saturday, between 11:00 am and 5:00 pm, Eastern Time.
Contact PSI about the examinations, fees, dates, locations, exam content and grade notifications.
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 two (2) years. The certificate may be renewed at the end of such period by renewing the license online via the Board’s website at www.sos.ga.gov and submitting the applicable renewal fee by the expiration date. The renewal fee increases if submitted after the expiration date of the apprentice license. If the apprentice is changing a master supervisor, or salon location, or if the salon where the apprentice has a change in its license status, the apprentice must submit a shop change application.
2.Upon the expiration of the last certificate of registration issued, such person shall not be permitted to practice the occupation in any way until he or she obtains his or her master cosmetology license.
|
|
|
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 $45.00 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: |
COSMETOLOGIST |
--- 3,000 HOURS AND 18 MONTHS OF TRAINING |
HAIR DESIGNER |
--- 2,650 HOURS AND 14 MONTHS OF TRAINING |
ESTHETICIAN |
--- 2,000 HOURS AND 18 MONTHS OF TRAINING |
NAIL TECHINICAN --- 1,050 HOURS AND |
8 MONTHS OF TRAINING |
Revision Date July 2012 |
2 |
GEORGIA STATE BOARD OF COSMETOLOGY 237 Coliseum Drive • Macon, Georgia 31217 • (478) 207-2440
www.sos.ga.gov/plb/cosmetology
Application for Cosmetology Apprentice, Fee $45.00 (non-refundable)
License Type: |
|
Cosmetology Apprentice |
|
|
|
Esthetician Apprentice |
|
|
|
Nail Technician Apprentice |
|
|
|
Hair Design Apprentice |
Please check the appropriate box:
Initial Application
Renewal Application ($90.00 late renewal)
Change of Shop or Master Application
Additional License Types (currently or previously issued by the Georgia Professional Licensing Boards):
Method Obtained by:
Applicant is applying for above referenced license to obtain:
( ) Apprentice Training as an apprentice for examination
Name
|
First |
Middle |
Last |
Name as shown on records or transcripts |
|
(if different) |
|
|
|
First |
Middle |
Last |
Social Security Number ______-_____-________ Date of Birth ___________
*THIS 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.
Physical Address
|
Number and Street |
Apt. No |
City/State |
Zip |
|
P.O. Box not acceptable |
|
|
|
Mailing Address |
|
|
|
|
(If different) |
Number and Street |
Apt. No |
City/State |
Zip |
(If you are granted a license, your name, mailing address and license number become public information and will be posted on the Secretary of State’s website. The mailing address is used for renewal notices, and application
processing)
Telephone Number Day |
|
Telephone Number Evening |
|
E – Mail |
|
Fax Number |
*Acknowledgement of your application will be sent by email. Also, if further information is needed, email is the most efficient way for Board staff to contact you so that your application can be processed in the most efficient manner. Your email address will not be shared with third parties.
Revision Date July 2012 |
3 |
COSMETOLOGY APPRENTICE LICENSE APPLICATION
Section 1 (completed by apprentice) This application will be returned if you do not answer the questions on this page.
Have you ever been convicted of a felony or misdemeanor (other than minor traffic violation) or entered a plea of guilty, nolo contendere or under the “First Offender Act,” or been sanctioned by another board or agency? DUI and DWI are not
minor traffic violations.
Yes No
Have you ever had a license revoked, suspended, or otherwise sanctioned by any professional licensing board or agency, or have you ever been denied issuance of, or pursuant to disciplinary proceedings refused renewal of a license by any professional licensing board or agency in Georgia or any other state?
Yes No
If you answered “Yes” to the question regarding court convictions, you must submit to the Board the following: a) a copy of conviction/sentencing document(s) from the Court before which you were convicted and sentenced, signed by the presiding judge, and showing said conviction and sentence; AND, if applicable, b) a statement (on official letterhead) from your probation / parole officer regarding your current status/completion of any probation / parole. Your application will not be processed until this information is received and reviewed by the
Board.
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.
Please check here if you answered yes to the question above and have already submitted the documentation to the Board within the past two years. If you have, it is not necessary to resubmit this information, but new convictions must be submitted.
I understand the following: 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 period of time that the apprentice, master and salon license are active. Only one apprentice renewal is allowed.
Yes ________No
Revision Date July 2012 |
4 |
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 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 pursuant to O.C.G.A. § 50-36-1:
1) _______ I am a United States citizen 18 years of age or older. Please submit a copy of your current
Secure and Verifiable Document(s) such as driver’s license, passport, or document as indicated on pages 22 & 23 of this application.
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. Please 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.
In making the above attestation, I understand that any failure to make full and accurate disclosures may result in disciplinary action by the Georgia State Board of Cosmetology and/or criminal prosecution.
_____________________________________________________
Signature of ApplicantDate
_____________________________________________________
Print Applicant’s Name
Personally appeared before me, the undersigned official authorized to administer oaths, comes
_______________________________who deposes and swears that he/she is the person who executed this
(Applicant’s Name)
application for a license by examination for Cosmetology in the State of Georgia; and that all of the statements
herein contained are true to the best of his/her knowledge and belief.
Sworn to and subscribed before me this ______ day of ___________________, 2________
Notary Public Signature ________________________________ |
________________________________ |
|
County |
State |
My Commission Expires ______________________
(seal)
Revision Date July 2012 |
5 |
Section 2
Name of SALON/SHOP where Apprentice will receive training (ATTACH COPY OF CURRENT LICENSE):
COSMETOLOGY SALON/SHOP NAME - MUST BE EXACTLY AS IT APPEARS ON THE LICENSE
SALON/SHOP PHYSICAL AND MAILING ADDRESS - MUST BE EXACTLY AS IT APPEARS ON THE LICENSE
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Salon/Shop License Number |
|
|
|
|
|
|
|
|
|
|
|
|
Salon/Shop Telephone Number: |
- |
|
|
- |
|
|
|
|
|
Have you ever previously registered as an apprentice? |
|
|
Yes |
|
|
No |
If YES, When? |
|
|
What type of apprenticeship? |
|
|
|
|
|
|
|
|
License Number |
|
|
Did you complete the apprenticeship? [ |
] Yes |
[ ] No. |
Are you currently working under an apprentice license? [ |
] Yes [ ] No. If YES, give date of license expiration |
I UNDERSTAND THAT IN ORDER FOR ME TO QUALIFY FOR THE EXAMINATIONS OFFERED BY THE COSMETOLOGY BOARD, I MUST PROVIDE PROOF OF A HIGH SCHOOL DIPLOMA, OR GED DIPLOMA, OR A POSTSECONDARY EDUCATION, OR COLLEGE DEGREE.
Signature of Apprentice Applicant
Printed Name of Applicant
Sworn to and Subscribed before me on this |
|
day of |
20 |
. |
|
|
|
|
|
|
|
Notary Signature
NOTARY SEAL
My commission expires on |
/ |
/ |
Revision Date July 2012 |
6 |
Section 3. Questions for the Master Cosmetologist, Hair Designer, Esthetician or Nail Technician
Supervising the Apprentice:
Apprentice Name: _______________________________________________________________
Supervisor Name: _____________________________ License No. ______________________
(for this application)
Have you ever been convicted of a felony or misdemeanor (other than minor traffic violation) or entered a plea of guilty, nolo contendere or under the “First Offender Act,” or been sanctioned by another board or agency? DUI
and DWI are not minor traffic violations. Yes No
If you answered “Yes” to the question regarding court convictions, you must submit to the Board the following: a) a copy of conviction/sentencing document(s) from the Court before which you were convicted and sentenced, signed by the presiding judge, and showing said conviction and sentence; AND, if applicable, b) a statement (on official letterhead) from your probation / parole officer regarding your current status/completion of any probation / parole. Your application will not be processed until this information is received and reviewed by the Board.
Have you ever had a license revoked, suspended, or otherwise sanctioned by any professional licensing board or agency, or have you ever been denied issuance of, or pursuant to disciplinary proceedings refused renewal of a license by any professional licensing board or agency in Georgia or any other state? Yes No
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.
_____ Please check here if you answered yes to the question above and have already submitted the documentation to the Board within
the past two years. If you have, it is not necessary to resubmit this information, but new convictions must be submitted.
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Salon/Shop owner or manager or master trainer, are responsible for keeping daily record of apprentice hours.
Salon/Shop owner or manager and master trainer are responsible for apprentice having a thorough understanding of sanitization. Refer to sanitation tip sheet.
Master trainer always monitors apprentice’s sanitation procedure.
Do you have cosmetology books/workbook for apprentice to study?
Do you have the sanitary regulations for apprentice to study?
Do you have the rules of the Georgia Board of Cosmetology for apprentice to study?
Does apprentice have related kit, and all the tools they will need to learn the specific profession in cosmetology?
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 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 period of time that the apprentice, master and salon license are active. Only one apprentice renewal is allowed.
Yes No I understand that failure to have apprentice reports and/or records current shall result in a fine of $200.00 (Rules 130-2-.06(2)(a)(b)(c) and 130-7-.04(a)(5).)
Revision Date July 2012 |
7 |
Yes No I understand that 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 $500.00 (Rules 130-2-
.06(a)(c), 130-2-.09, 130-4-.06, and 130-7-.04(a)(6).)
APPRENTICE HOURS ARE SUBTOTALED 1ST OF JANUARY, 1ST OF APRIL, AND 1ST OF SEPTEMBER. HOURS REPORTED WILL BE KEPT ON FILE BY SALON/SHOP OWNER OR MANAGER FOR INSPECTOR TO REVIEW.
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. It is your responsibility to submit these hours at the end of the apprenticeship or once the apprentice is no longer training with you.
I agree to act as supervising 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.
STATE OF GEORGIA |
|
COUNTY OF ___________________________________ |
______________________________________________ |
|
SIGNATURE OF THE MASTER SUPERVISING THE |
|
APPRENTICE |
SUBSCRIBED AND SWORN TO BEFORE ME THIS |
|
|
______________________________________________ |
________ DAY OF _____________________, _________ |
PRINT NAME |
_______________________________________________ |
______________________________________________ |
NOTARY PUBLIC |
DATE |
MY COMMISSION EXPIRES: _____________________ |
|
Revision Date July 2012 |
8 |
GEORGIA STATE BOARD OF COSMETOLOGY
237 COLISEUM DRIVE
MACON, GA 31217
TRANSCRIPT OF COSMETOLOGY APPRENTICE TRAINING
It is hereby certified that___________________________________________________
Apprentice Last NameFirst NameMiddle Name
Apprentice License. #__________________________
Salon Name _________________________________ Salon 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 period of time that the apprentice, master and salon license are active. Only one apprentice renewal is allowed.
|
|
|
|
|
|
|
|
|
COURSES |
Hours Completed |
|
|
|
|
|
|
|
|
|
|
700 hrs. |
|
THEORY in any category one clock hour equals one credit hour |
|
|
|
|
|
|
|
|
|
|
|
250 hrs. |
|
HAIRCUTTING AND SHAPING 1 haircut =.75 HRS |
|
|
|
|
|
|
|
|
1 shampoo =.25 hrs 1 temp rinse =.75 hrs |
|
|
|
|
660 hrs. |
|
SHAMPOOING HAIRDRESSING & STYLING 1 shampoo & |
|
|
|
|
|
|
|
|
style or 1 pressing, curling & comb-out 1.5 hrs |
|
|
|
|
250 hrs. |
|
HAIR-COLOR OR BLEACHING 1 color including style=2 hrs |
|
|
|
|
|
|
|
|
or 1 bleach including style=2.5 hrs |
|
|
|
|
360 hrs. |
|
PERMANENT 1 cold or heat wave including style = 3 hrs |
|
|
|
|
|
|
|
|
SCALP TREATMENT # 1 scalp treatment = 1 hrs |
|
|
|
|
250 hrs. |
|
FACIALS 1 facial = 1 hrs |
|
|
|
|
|
|
|
|
MAKEUP ARCHING ESTHETICS 1 brow & lash |
|
|
|
|
|
|
|
|
tint=.5hrs |
|
|
|
|
|
|
|
100 hrs. |
|
CHARM, RECEPTION, ART & ETHICS, STATE LAWS AND |
|
|
|
|
|
|
|
|
BOARD RULES |
|
|
|
|
|
|
|
|
|
|
|
|
70 hrs. |
|
MANICURE |
1 manicure = 1 hrs |
|
|
|
|
|
|
|
|
1 sculptured nails application = 3 hrs |
|
|
|
|
|
|
|
|
PEDICURE # 1 pedicure = 1 hrs |
|
|
|
|
200 hrs. |
|
CHEMICAL & RELAXING |
|
|
|
|
|
|
|
|
1 chemical relaxer = 2 hrs |
|
|
|
|
100 hrs. |
|
LABORATORY Training in all chemicals including sanitation one clock hour |
|
|
|
|
|
|
|
|
= one credit hour. |
|
|
|
|
60 hrs. |
|
Additional Instruction |
|
|
|
|
|
|
|
|
|
|
|
|
|
3000 |
|
|
|
TOTAL HOURS |
|
|
|
|
HRS. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sworn to and subscribed before me |
|
|
|
|
|
This |
|
day of |
|
|
20 |
|
|
|
|
|
|
|
|
|
|
|
|
NOTARY SEAL |
Notary Signature |
|
|
|
|
My commission expires on |
/ |
/ |
|
|
|
|
Revision Date July 2012 |
|
|
|
|
|
9 |
GEORGIA STATE BOARD OF COSMETOLOGY
237 COLISEUM DRIVE
MACON, GA 31217-3858
HOW TO CHANGE FROM CLOCK HOURS TO CREDIT HOURS
THEORY
An apprentice can study theory in any category for one clock hour and get 1 credit hour.
HAIRCUTTING AND SHAPING
One haircut = .75 of a credit hour.
One shampoo = .25 of a credit hour.
A temp rinse = .75 of a credit hour.
SHAMPOOING HAIRDRESSING AND STYLING
One shampoo and style or one pressing, curling and comb-out= 1.5 credit hours.
HAIR-COLOR OR BLEACHING
One color including style = 2 credit hours.
A bleach including style = 2.5 credit hours
PERMANENT
One cold or heat wave including style = 3 credit hours.
SCALP TREATMENT
One scalp treatment = 1 credit hour.
FACIALS AND MAKE-UP, ARCHING AND ESTHETICS
One facial = 1credit hour.
One brow and lash tint = .5 of a credit hour.
CHARM RECEPTION ART AND ETHICS
One hour learning how to work the desk and how to deal properly with clients for one clock hour = 1 credit hour.
MANICURE AND PEDICURE
One manicure = 1 credit hour.
One pedicure = 1 credit hour.
One sculptured nail application (full set) = 3 credit hours.
CHEMICAL AND RELAXING
One chemical relaxer = 2 credit hours.
LABORATORY
An apprentice will get training in preparing germicidal solutions, shampoos, tint and bleaches, practical training in washing and sanitizing all equipment in the beauty salon each. Each clock hour of this training will be equal to 1 credit hour.
PLEASE NOTE: CREDIT/CLOCK HOURS ARE THE SAME.
Revision Date July 2012 |
10 |
GEORGIA STATE BOARD OF COSMETOLOGY
237 COLISEUM DRIVE
MACON, GA 31217-3858
TRANSCRIPT OF HAIR DESIGNER APPRENTICE TRAINING
It is hereby certified that___________________________________________________
Apprentice Last Name |
First Name |
Middle Name |
Apprentice License. #__________________________ |
|
Salon Name _________________________________ Salon Lic#__________________
Completed the following hours from ____________________to___________________
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 period of time that the apprentice, master and salon license are active. Only one apprentice renewal is allowed.
|
|
|
Hours |
|
|
|
Courses |
Hours |
|
|
|
Required |
|
|
|
|
Completed |
|
|
|
|
|
|
|
|
|
700hrs. |
THEORY in any category one clock hour equals one credit hour |
|
|
|
|
|
|
|
|
|
|
320 hrs. |
HAIRCUTTING AND SHAPING 1 haircut =.75 HRS |
|
|
|
|
|
|
1 shampoo =.25 hrs 1 temp rinse =.75 hrs |
|
|
|
|
280 hrs. |
SHAMPOOING HAIRDRESSING & STYLING 1 shampoo |
|
|
|
|
|
|
& style or 1 pressing, curling & comb-out 1.5 hrs |
|
|
|
|
350 hrs. |
HAIR-COLOR OR BLEACHING 1 color including style=2 |
|
|
|
|
|
|
hrs or 1 bleach including style=2.5 hrs |
|
|
|
|
430 hrs. |
PERMANENT 1 cold or heat wave including style = 3 hrs |
|
|
|
|
|
|
|
|
|
|
100 hrs. |
SCALP TREATMENT # 1 scalp treatment = 1 hrs |
|
|
|
|
|
|
|
|
|
|
100 hrs. |
CHARM,RECEPTION, ART & ETHICS, STATE LAW AND |
|
|
|
|
|
|
BOARD RULES |
|
|
|
|
|
|
|
|
|
|
270 hrs. |
CHEMICAL & RELAXING |
|
|
|
|
|
|
1 chemical relaxer = 2 hrs |
|
|
|
|
100 hrs. |
LABORATORY Training in all chemicals including sanitation one clock |
|
|
|
|
|
|
hour = one credit hour. |
|
|
|
2650 |
|
TOTAL HOURS |
|
|
|
|
Hrs. |
|
|
|
|
|
|
|
|
|
Sworn to and subscribed before me |
|
This |
|
|
Day of |
|
|
20 |
|
|
|
Notary Signature
NOTARY SEAL
Revision Date July 2012 |
11 |
GEORGIA STATE BOARD OF COSMETOLOGY
237 COLISEUM DRIVE
MACON, GA 31217-3858
HOW TO CHANGE FROM CLOCK HOURS TO CREDIT HOURS
THEORY
An apprentice can study theory in any category for one clock hour and get 1 credit hour.
HAIRCUTTING AND SHAPING
One haircut = .75 of a credit hour.
One shampoo = .25 of a credit hour.
One temp rinse = .75 of a credit hour.
SHAMPOOING HAIRDRESSING AND STYLING
One shampoo and style or one pressing, curling and comb-out it = 1.5 credit hours.
HAIR-COLOR OR BLEACHING
One color including style = 2 credit hours.
One = bleach including style for 2.5 credit hours
PERMANENT
One cold or heat wave including style = 3 credit hours.
SCALP TREATMENT
One scalp treatment = 1 credit hour.
CHARM RECEPTION ART AND ETHICS
One hour learning how to work the desk and how to deal properly with clients for one clock hour = 1 credit hour.
CHEMICAL AND RELAXING
One chemical relaxer = 2 credit hours.
LABORATORY
An apprentice will get training in preparing germicidal solutions, shampoos, tint and bleaches, practical training in washing and sanitizing all equipment in the beauty salon each. Each clock hour of this training will be equal to 1 credit hour.
Revision Date July 2012 |
12 |
GEORGIA STATE BOARD OF COSMETOLOGY
237 COLISEUM DRIVE
MACON, GA 31217-3858
TRANSCRIPT OF NAIL CARE APPRENTICE TRAINING
It is hereby certified that___________________________________________________
Apprentice Last NameFirst NameMiddle Name
Apprentice License. #__________________________
Salon Name _________________________________ Salon 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 period of time that the apprentice, master and salon license are active. Only one apprentice renewal is allowed.
|
|
|
Hours |
|
|
|
|
Courses |
|
Hours |
|
|
|
|
Required |
|
|
|
|
|
|
Completed |
|
|
|
|
|
|
|
|
|
|
|
|
|
280 hrs. |
|
THEORY in any category one clock hour equals one credit hour |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
140 hrs. |
|
MANICURE W/ HAND & FOREARM MASSAGE |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20 hrs. |
|
ARTIFICIAL NAIL REMOVAL & NAIL REPAIR |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
60 hrs. |
|
NAIL FILL IN APPLICATIONS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
120 hrs. |
|
ARTIFICIAL TIP APPLICATION W/OVERLAY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40 hrs. |
|
NAIL WRAPPING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
180 hrs. |
|
NAIL SCULPTURING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
120 hrs. |
|
PEDICURE W/FOOT AND LEG MASSAGE |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20 hrs. |
|
NAIL ARTS TECHNINQUES |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10 hrs. |
|
PROFESSIONAL DRILL USAGE W/DRILL DESIGNS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10 hrs. |
|
AIR BRUSH NAIL ART |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10 hrs. |
|
PARAFFIN TREATMENTS (HAND & FEET) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
40 hrs. |
|
RELATED SUBJECTS AND ADVANCED TECHNIQUES |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1050 |
|
|
TOTAL HOURS |
|
|
|
|
|
|
Hrs. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sworn to and subscribed before me |
|
|
|
|
|
|
This |
|
|
Day of |
|
|
|
20 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Notary Signature |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
NOTARY SEAL |
|
|
My commission expires on |
/ |
/ |
|
|
|
|
|
Revision Date July 2012 |
|
|
|
|
|
|
13 |
GEORGIA STATE BOARD OF COSMETOLOGY
237 COLISEUM DRIVE
MACON, GA 31217-3858
HOW TO CHANGE FROM CLOCK HOURS TO CREDIT HOURS FOR
NAIL CARE APPRENTICES.
THEORY
An apprentice can study theory in any category for one clock hour and get 1 credit hour.
MANICURING
One manicure with hand and a forearm massage = 1 credit hour.
ARTIFICIAL NAILS
Artificial tip application with overlay (gel or acrylic) = 3 credit hours.
One fill in application = 1.5 credit hours.
One set sculptured nails = 3 hours.
Natural nail overlay = 1 credit hour.
One repair and artificial removal = .50 credit hours.
One natural nail wrap (silk or linen) =1 credit hour.
PEDICURE
One pedicure and foot massage = 1 credit hour.
NAIL ARTS AND ETHICS
One clock hour = one credit hour.
RELATED SUBJECTS
Professional nail drill usage = .50 credit hours.
Nail art & airbrush techniques, full set = 1 credit hour.
Hot oil treatment = .50 credit hour.
Paraffin treatment = .50 credit hour.
ADDITIONAL INSTRUCTION
Additional instruction in any category for one clock hour = 1 credit/clock hour.
Revision Date July 2012 |
14 |
MM/DD/YYYYMM/DD/YYYY
GEORGIA STATE BOARD OF COSMETOLOGY
237 COLISEUM DRIVE
MACON, GA 31217-3858
TRANSCRIPT OF ESTHETICIAN APPRENTICE TRAINING It is hereby certified that
|
|
Apprentice Last name |
First name |
Middle |
Apprentice License # |
|
|
|
|
|
Salon Name |
|
|
Salon License No. |
|
Completed the following hours from ____________________to___________________
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 period of time that the apprentice, master and salon license are active. Only one apprentice renewal is allowed.
|
|
|
Hours |
|
|
|
|
Courses |
Hours |
|
|
|
Required |
|
|
|
|
|
Completed |
|
|
|
|
|
|
|
|
|
|
300 hrs. |
|
PROFESSONAL PRACTICES |
|
|
|
|
|
|
|
|
|
|
|
40 hrs. |
|
PROFESSIONAL ETHICS |
|
|
|
|
|
|
|
|
|
|
|
160 hrs. |
|
BUSINESS PRACTICES |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
640 hrs. |
|
SCIENCES |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
150 hrs. |
|
BODY TREATMENT |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
230 hrs. |
|
FACIALS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
180 hrs. |
|
MAKE-UP |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
150 hrs. |
|
HAIR REMOVAL |
|
|
|
|
|
|
|
|
|
|
|
150 hrs. |
|
SPA/SALON MANAGEMENT |
|
|
|
|
|
|
|
|
|
|
2000 |
|
|
TOTAL HOURS |
|
|
|
|
Hrs. |
|
|
|
|
|
|
|
|
|
|
|
|
|
Sworn to and subscribed before me |
|
|
|
|
This |
|
|
Day of |
|
|
|
20 |
|
|
|
|
|
|
|
|
|
|
|
Notary Signature |
|
|
|
|
|
NOTARY SEAL |
My commission expires on |
/ |
/ |
|
|
|
Revision Date July 2012 |
15 |
GEORGIA STATE BOARD OF COSMETOLOGY
237 COLISEUM DRIVE
MACON, GA 31217-3858
HOW TO CHANGE FROM CLOCK HOURS TO CREDIT HOURS FOR ESTHETICANS.
THEORY; Professional Practices, Professional Ethics, Business Practices
An apprentice can study theory in any category for one clock hour and get 1 credit hour.
SCIENCES
Sciences, in any category, one clock hour = 1 credit hour.
BODY TREATMENT
One body treatment = 1credit hour.
FACIALS
One facial = 1 credit hour.
MAKE-UP
One make-up = 1 credit hour.
HAIR REMOVAL
One hair removal or waxing (lip, chin, face) = 1 credit hour.
One leg hair removal = 2 credit hours.
One bikini hair removal = .50 credit hours.
One arching = .50 credit hours.
ADDITIONAL INSTRUCTION
One brow and lash tinting = 1 credit hour.
Revision Date July 2012 |
16 |
Georgia Board of Cosmetology - Cosmetology Apprentice Daily Log - Month/Year______________
Apprentice license number ____________ Print apprentice name _________________________ Signature of apprentice _________________________
|
Sworn to and subscribed before me |
SEAL |
Printed Name of Master _____________________________ |
|
This _______Day of ____________, 20 _____ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Day |
Theory |
Hair & |
Shampooing |
Hair |
|
Perm. & |
|
Facials |
Charm |
Manicure |
Chemical |
Lab. I |
Additional |
Total |
|
|
Cutting |
Hairdressing |
Coloring |
|
Scalp |
|
Make- |
Reception |
& |
& |
|
Instruction |
Hours |
|
|
|
|
Pedicure |
|
|
|
Shaping |
Styling |
Bleaching |
|
Treatments |
|
up |
Art & |
Relaxing |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Esthetics |
Ethics, |
|
|
|
|
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
13 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
23 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
24 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
25 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
26 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
27 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
28 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
29 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
31 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Signature of Master ________________________________ |
|
Signature of Notary _________________________ |
|
|
|
|
|
|
|
|
|
My commission expires: |
|
|
|
|
|
Master License # ____________________________ |
|
|
Printed name of salon/shop owner or manager: |
|
|
|
Signature of Salon/Shop Owner/Mgr: |
|
|
|
________________________________________ |
______________________________________________________________ |
Revision Date July 2012 |
17 |
Georgia Board of Cosmetology Hair Designer Apprentice Daily Log - Month/Year______________
Apprentice license number ____________ Print apprentice name _________________________ Signature of apprentice _________________________
Sworn to and subscribed before me |
|
SEAL |
Printed Name of Master _____________________________ |
This _______Day of ____________, 20 _____ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Charm, |
|
|
|
|
|
|
Hair & |
Shampooing |
|
Hair |
|
Perm. |
Scalp |
Reception |
Chemical |
Lab. I |
Total |
|
Day |
Theory |
Cutting |
Hairdressing |
|
Coloring |
|
Treat- |
Treat- |
Art & |
& |
|
Hours |
|
Styling |
|
|
Relaxing |
|
|
|
|
Shaping |
|
Bleaching |
|
ments |
ment |
ethics, |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
13 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
23 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
24 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
25 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
26 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
27 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
28 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
29 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
|
|
|
|
|
|
|
|
|
|
31 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Signature of Master ________________________________ |
Signature of Notary _________________________ |
|
|
|
|
|
|
|
|
My commission expires: |
|
|
|
|
|
Master License # ____________________________ |
Printed name of salon/shop owner or manager: |
|
|
|
Signature of Salon/Shop Owner/Mgr: |
|
|
________________________________________ |
____________________________________________________________ |
Revision Date July 2012 |
18 |
Georgia Board of Cosmetology Nail Technician Apprentice Daily Log- Month/Year______________
Apprentice license number ____________ Print apprentice name _________________________ |
Signature of apprentice _________________________ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Manicure |
Artificial |
Nail Fill In |
Artificial |
Nail |
Nail |
Pedicure |
Nail |
Professional |
Air |
Paraffin |
Related |
Total |
Day Theory w/ hand / |
Nail |
Applications |
Tip App. |
Wrap- |
Sculp- |
w/foot |
arts |
Drill Usage |
Brush |
Treat- |
Subjects / |
Hours |
forearm |
Removal |
|
w/Overlay |
ping |
turing |
and leg |
tech- |
w/ drill |
Nail |
ment |
Advanced |
|
|
massage |
& Nail |
|
|
|
|
massage |
nique |
designs |
Art |
(Hand |
Tech. |
|
|
|
Repair |
|
|
|
|
|
|
|
|
& feet |
|
|
|
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Sworn to and subscribed before me |
SEAL |
Printed Name of Master _____________________________ |
This _______Day of ____________, 20 _____ |
|
|
|
|
Signature of Master ________________________________ |
Signature of Notary _________________________ |
|
|
My commission expires: |
|
Master License # ____________________________ |
Printed name of salon/shop owner/mgr : __________________ |
Signature of Salon/Shop Owner/Mgr:__________________________ |
Revision Date July 2012 |
19 |
Georgia Board of Cosmetology Esthetician Apprentice Daily Log - Month/Year______________
Apprentice license number ____________ Print apprentice name _________________________ Signature of apprentice _________________________
|
Prof. |
Prof. |
Business |
|
Sciences |
|
Body |
Facials |
Make-up |
Hair |
Spa/Salon |
Total |
|
Day |
Practices |
Ethics |
Practices |
|
|
|
Treatment |
|
|
Removal |
Manag- |
Hours |
|
|
|
|
|
|
|
|
ment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
11 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
12 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
13 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
17 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
18 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
19 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
20 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
21 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
23 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
24 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
25 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
26 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
27 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
28 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
29 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
30 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
31 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sworn to and subscribed before me |
|
SEAL |
Printed Name of Master _____________________________ |
This _______Day of ____________, 20 _____ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Signature of Master ________________________________ |
Signature of Notary _________________________ |
|
|
|
|
|
|
|
|
My commission expires: |
|
|
|
|
|
Master License # ____________________________ |
Printed name of salon/shop owner or manager : |
|
|
Signature of Salon/Shop Owner/Mgr: |
|
|
________________________________________ |
____________________________________________________________ |
Revision Date July 2012 |
20 |
APPLICANT: PLEASE CHECK THE FORM OF IDENTIFICATION BELOW THAT YOU POSSESS. RETURN THIS FORM ALONG WITH A COPY OF YOUR APPROPRIATE DOCUMENTATION.
________________________________________
Name
Secure and Verifiable Documents Under O.C.G.A. § 50-36-2
Issued August 1, 2011 by the Office of the Attorney General, Georgia
The Illegal Immigration Reform and Enforcement Act of 2011 (“IIREA”) provides that “[n]ot
later than August 1, 2011, the Attorney General shall provide and make public on the
Department of Law’s website a list of acceptable secure and verifiable documents. The list shall be reviewed and updated annually by the Attorney General.” O.C.G.A. § 50-36-2(f). The
Attorney General may modify this list on a more frequent basis, if necessary.
The following list of secure and verifiable documents, published under the authority of O.C.G.A.
§50-36-2, contains documents that are verifiable for identification purposes, and documents on this list may not necessarily be indicative of residency or immigration status.
_____ A United States passport or passport card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A United States military identification card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A driver’s license issued by one of the United States, the District of Columbia, the
Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____An identification card issued by one of the United States, the District of Columbia, the
Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A tribal identification card of a federally recognized Native American tribe, provided that it
contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer. A listing of federally recognized Native American tribes may be found at: http://www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/TribalDirectory/ind
ex.htm [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A United States Permanent Resident Card or Alien Registration Receipt Card [O.C.G.A. § 50-36-
_____An Employment Authorization Document that contains a photograph of the bearer [O.C.G.A. § 50-
36-2(b)(3); 8 CFR § 274a.2]
_____A passport issued by a foreign government [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
Revision Date July 2012 |
21 |
_____A Merchant Mariner Document or Merchant Mariner Credential issued by the United States Coast
Guard [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A Free and Secure Trade (FAST) card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]
_____A NEXUS card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]
_____A Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card [O.C.G.A. §50-36-
2(b)(3); 22 CFR § 41.2]
_____A driver’s license issued by a Canadian government authority [O.C.G.A. § 50-36-2(b)(3); 8 CFR §
274a.2]
_____A Certificate of Citizenship issued by the United States Department of Citizenship and Immigration
Services (USCIS) (Form N-560 or Form N-561) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11]
_____A Certificate of Naturalization issued by the United States Department of Citizenship and
Immigration Services (USCIS) (Form N-550 or Form N-570) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11]
_____In addition to the documents listed herein, if, in administering a public benefit or program, an
agency is required by federal law to accept a document or other form of identification for proof of or documentation of identity, that document or other form of identification will be deemed a secure and verifiable document solely for that particular program or administration of that particular public benefit. [O.C.G.A. § 50-36-2(c)]
Revision Date July 2012 |
22 |
