Form Bol-Bar-Bs-59 - Barber Student Registration Form printable pdf download

STATE OF IDAHO

BUREAU OF OCCUPATIONAL LICENSES

1109 Main Street, Suite 220

Boise, Idaho 83702-5642

(208) 334-3233

mlondon@ibol.state.id.us

BARBER STUDENT REGISTRATION FORM

Complete this form by providing (please print) the requested information and submit it to the address noted above. The applicant’s

signature must be notarized and the fee ($20.00) must be attached. Returned checks are subject to a $20.00 collection fee..

NOTE: NO BARBER SCHOOL SHALL PERMIT A STUDENT TO ENGAGE IN THE PRACTICE OF BARBERING OR

ATTEND ANY CLASSES UNTIL AFTER SUCH STUDENT HAS PRESENTED THE STUDENT BARBER PERMIT

ISSUED IN THE STUDENT'S NAME BY THE BOARD.

I hereby submit my application to be registered as a barber student in the State of Idaho under the provisions of Title 54,

Chapter 5, Idaho Code as amended.

1. Full Name (Mr., Mrs., or Ms.) _____________________________________________________________________________

2. Mailing address__________________________________________________________________________________________

Street

City

State

Zip

3. Place of Birth

Date of Birth _______/_______/_______

month

day

year

(Proof of being 16 ½ years of age must be attached. A copy of your birth certificate, passport, military ID, or valid driver’s license is

acceptable.)

4. Social Security No. ______-____-______ Home phone number (____)____________ E-mail __________________________

5. Do you have at least a tenth (10

) grade education or the equivalent?

[ ] Yes

[ ] No

(Proof of education must be provided to the school & attached. A copy of school diploma, transcript, GED, or CPAt is acceptable.)

6. Name of Barber school in which training will be received: _______________________________________________________

7. Have you ever been convicted of any felony?

[ ] Yes

[ ] No

(If yes, please attach a detailed statement, including a summary of the charges, the final order, any probation or parole documentation,

and any other relevant information.)

8. Have you received prior barber training in Idaho?

[ ] Yes

[ ] No

(If yes, please attach the name of the school you attended, your name (if different), and the dates you attended.)

AFFIDAVIT

I hereby certify that I am the person named above and that I have no infectious or contagious disease which may pose a threat to the

that I am of good moral character and temperate habits. I swear or affirm

general public and

that the information provided on

and attached to this application is true and accurate to the best of my knowledge and belief. I understand that registration is conditional

on the verification of the fee and information I have provided.

_____________________________________________________

Signature of applicant

State of ______________, County of _________________, ss.

Subscribed and sworn before me this ______ day of _______________________, 20 _____.

(seal)

______________________________________________________

Notary Public official signature

residing at_____________________________________________

my commission expires___________________________________

(continued)

BOL-BAR-BS-59-revised 06/99

Form Bol-Bar-Bs-59 - Barber Student Registration Form

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