Application For Certificate Of Registration/renewal As An Athlete Agent Form Page 2

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5c.
Business or occupation engaged in for the five years immediately preceding the date of application:
YEAR
_____
____________________________________________________
_____
____________________________________________________
_____
____________________________________________________
_____
____________________________________________________
_____
____________________________________________________
5d.
Record of all felony or misdemeanor arrests, charges and convictions of the applicant (other than
minor traffic offenses such as speeding):
CHECK HERE IF NONE:
Felony
Arrests/Charges
Location
Date
Disposition
Conviction
Y
N
a.
Y
N
b.
Y
N
c.
(Attach additional sheets if necessary)
Misdemeanor
Arrests/Charges
Location
Date
Disposition
Conviction
Y
N
a
.
Y
N
b.
Y
N
c.
(Attach additional sheets if necessary)
6.
Names and addresses of all persons, except employees on stated salaries, who have a financial
interest as partners, associates, or profit sharers in the operation of the business of the athlete
agent:
Name
Address
.
a
b.
c.
(Attach additional sheets if necessary)

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