Form Bah - Barber And Hairdresser Application - Alaska Department Of Community And Economic Development Page 6

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If the applicant's license has lapsed or expired, please explain why (e.g., failure to pay licensing renewal fees, etc.)
Has the applicant's license ever been suspended or revoked?
If so, for what reason?
Has the applicant been subject to any disciplinary action(s) (e.g., letter of warning, stipulation)? Please describe?
Please provide any information you believe relevant to the applicant's qualifications to practice:
General Comments:
[BOARD SEAL]
Signature
Printed Name
PLEASE MAIL DIRECTLY TO
THE STATE OF ALASKA
Title
State Board
Date
STATE OF ALASKA
DEPARTMENT OF COMMUNITY AND
ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
BOARD OF BARBERS AND HAIRDRESSERS
PO BOX 110806
JUNEAU AK 99811-0806
08-4193d (Rev. 2/01)

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