Tennessee Form In 1655 – Fill Out and Use This PDF

Locksmith Apprentice Application, Page 3

If yes, you are required to provide this office with certified court documents showing the disposition of these charges.

g. Have you ever been convicted of a felony offense? (A felony is an offense for which a jail sentence or probation of one

	(1) year or more could have been imposed.)	Yes	No
h.	Have you ever been convicted of an offense which involved fraud or theft?	Yes	No
	Persons convicted of offenses involving fraud or theft shall not be entitled to registration as a locksmith apprentice, refer to Tenn. Code Ann. § 62-
11-	112(b)(4).

i.If you pled guilty or were found guilty, what was the sentence of the court? (Indicate the fine, time in the county jail or penitentiary, deferred sentence, suspended sentence, or period of probation. List the sentence below and provide all final court dispositions with this application.)

______________________________________________________________________________________

DateChargeSentenceProbation Completed Date

_______________________________________________________________________________________

DateChargeSentenceProbation Completed Date

_______________________________________________________________________________________

Date			Charge		Sentence	Probation Completed Date
j.	Are you currently on a deferred sentence or on probation?					Yes	No
k.	Do you currently have charges pending against you?					Yes	No
	If yes, you are required to provide this office with certified court documents showing the disposition of these charges
	within thirty (30) days of these charges being resolved by conviction or dismissal, you must also provide your written
	explanation of the circumstances surrounding the charges and the arresting officer’s report. (Attach a separate sheet
	of paper, if necessary.)
						______________________________
Date of Arrest			Charge		City and State	Arraignment/Court Date
						______________________________
Date of Arrest			Charge		City and State	Arraignment/Court Date
						______________________________
Date of Arrest			Charge		City and State	Arraignment/Court Date

5.Have you read the Tennessee statutes pertaining to Locksmiths and the corresponding Administrative Rules and

do you understand your responsibilities?

Yes No

I HAVE ENCLOSED: (***Required for Processing***)

Acceptable Identification

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. Cards must be completed using "black" ink only.

Final Court dispositions (Judgements) on any and all charges/arrests.

Locksmith Apprentice Application, Page 4

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.

_____________________________________________	_________________________
(Locksmith Apprentice Applicant Signature)	(Date Signed)

STATE OF TENNESSEE

DEPARTMENT OF COMMERCE & INSURANCE DIVISION OF REGULATORY BOARDS LOCKSMITH LICENSING PROGRAM

500 JAMES ROBERTSON PARKWAY, 2ND FLOOR NASHVILLE, TENNESSEE 37243-0570 615.532.3369 FAX 615.532.2965 www.tn.gov/commerce/boards

LOCKSMITH APPRENTICE - APPLICANT

INSTRUCTIONS

REMOVE THIS PAGE BEFORE SUBMITTING APPLICATION - RETAIN THIS INFORMATION FOR YOUR RECORDS

Application Fee:	$	50.00
Registration Fee:	$	25.00
ID Card:	$	25.00
Fingerprint Processing Fee:	$	60.00 (If this office processes your fingerprint cards)

Total Fees: $160.00 (If this office processes your fingerprint cards) $100.00 (if fingerprints electronically processed)

•Read and complete each portion of this application carefully.

•Applications submitted without required documents will not be processed until all required materials are submitted.

•All required supporting documents must be included with your application, any application which lacks required information or reflects a failure to meet any requirement for registration will only be held in a "pending" status for sixty (60) days. If the applicant fails to respond by submitting the required documents, fees, or information within sixty (60) days of any notice from this office, the application will be closed.

•If you fail to respond to any correspondence from this office, your application will be closed or denied.

•It is your responsibility to know and understand the laws and rules regulating locksmiths in the State of Tennessee.

•The photo identification card shall be carried by the registrant at all times when performing duties as a locksmith, and shall be shown upon request.

DOCUMENTS TO BE INCLUDED WITH APPLICATION

(1)Acceptable Identification (Proof that applicant is 16 years of age): Which includes at least one (1) of the following:

1.A driver’s license or non-driver’s license issued by the State DMV; or

2.A valid passport; or

3.A resident alien card or green card; or

4.A license or permit issued by a government agency; or

5.If the applicant is a city, state, or federal employee, an employee identification card

(2)Two (2) completed fingerprint cards or a copy of the receipt for electronically scanned prints. Fingerprints 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 and all questions in the blocks at the top of the cards must be answered. Cards must be completed using "black" ink only.

(3)Statements of any criminal records in each area where the applicant has resided. Persons convicted of offenses involving fraud or theft shall not be entitled to registration as a locksmith apprentice, refer to Tenn. Code Ann. § 62-11-111(b)(4). Persons convicted of a felony offense, persons who have been convicted of offenses involving the illegal use, possession, sale, manufacture, distribution or transportation of a controlled substance, drug, or narcotic, persons convicted of felonious assault, persons convicted of a crime involving unlawful breaking or entering, burglary, larceny or arson; or persons convicted as a habitual criminal may not be eligible for licensure, refer to Administrative Rule 0780-5-13-.02(8).

(4)Certified court documents: Applicants are required to provide certified court documents for each charge(s) or arrest(s) disclosed. Failure to submit the required court documents could result in the closure of your application.

(5)Two (2) frontal color passport-style photographs taken within the preceding three (3) months, which have your name and social security number written on the back of each photo.

(6)Locksmith Company Affiliation: All locksmith apprentices registered in Tennessee must be employed by a Registered Locksmith Company.

(7)Listing of Locksmiths: Refer to Tenn. Code Ann. § 62-11-112(b)

All locksmith apprentice applicants are required to provide a list of all locksmiths employed by the Locksmith Company employer with their application.