Application For Salesperson'S License
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1
2LOUISIANA USED MOTOR VEHICLE COMMISSION
FOR OFFICE USE ONLY
3132 Valley Creek Drive
Baton Rouge, Louisiana 70808
R#
MAIN# (225) 925-3870 FAX # (225) 925-3869
Current License #
Dealer #
APPLICATION FOR SALESPERSON’S LICENSE FOR YEAR 20___
SM #
Date Issued
INITIAL
RENEWAL
PLEASE PRINT OR TYPE. Complete entire application and attach such documents as required. Any misrepresentation or omission
of information shall be grounds for refusal to issue or revocation of a Salesperson License. SALESPERSON LICENSE FEE IS $25.00.
SECTION ONE: INDIVIDUAL INFORMATION
LAST NAME
FIRST NAME
MI
SOCIAL SECURITY #
RESIDENCE ADDRESS
CITY
STATE
ZIPCODE
DATE OF BIRTH mm/dd/yyyy
HOME TELEPHONE
CELLULAR PHONE
EMPLOYMENT DATE
DRIVER’S LICENSE #
RACE
GENDER
U.S. CITIZEN?
YES
NO IF NO, ATTACH COPY OF RESIDENT ALIEN CARD (FRONT AND BACK) AND DRIVER’S LICENSE.
SECTION TWO: DEALERHIP INFORMATION
DEALERSHIP NAME
DEALERSHIP ADDRESS
CITY
ZIPCODE
DEALER LICENSE #
TELEPHONE
PARISH
SECTION THREE: GENERAL INFORMATION
1.
HAVE YOU EVER APPLIED FOR A SALESPERSON LICENSE THAT WAS DENIED?
YES; IF YES, GIVE DATE(S): ____________________________________________________________
NO
2.
HAVE YOU EVER HELD A DEALER OR SALESPERSON LICENSE THAT WAS DENIED, SUPSENDED, OR REVOKED?
YES; IF YES, GIVE DEALERSHIP NAME AND DATE: ________________________________________________________________
NO
3.
ARE YOU RELATED TO ANYONE FROM THE USED CAR INDUSTY WHOSE LICENSE HAS BEEN DENIED, SUSPENDED, OR REVOKED?
YES; IF YES, GIVE NAME(S): __________________________________________________________________________________
NO
4.
HAVE YOU EVER ATTENDED THE 4 HOUR EDUCATIONAL SEMINAR?
YES; IF YES, GIVE DATE: ____________________________________________________________________________________
NO
5.
ARE YOU GOING TO DRIVE ANY OF THE VEHICLES ON OR OFF THE LOT?
YES
NO
SECTION FOUR: EMPLOYMENT HISTORY
HAVE YOU EVER HAD A PREVIOUS DEALER OR SALESPERSON LICENSE?
YES; IF YES, COMPLETE THE FOLLOWING:
NO
NAME OF DEALERSHIP
DEALERSHP ADDRESS
DATES OF LICENSE
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