Form Bah - Apprentice Enrollment Application Form - Alaska Department Of Community And Economic Development Page 2

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STATE OF ALASKA
DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
BOARD OF BARBERS AND HAIRDRESSERS
P.O. BOX 110806
JUNEAU, ALASKA 99811-0806
(907) 465-2547
E-mail: license@dced.state.ak.us
STATEMENT OF RESPONSIBILITY
TO BOARD OF BARBERS AND HAIRDRESSERS:
I,
, am willing to assume the full
responsibility of apprenticing
in the
practice of Barbering
Hairdressing
or Esthetics
at
Name of Shop and Address
The Shop Owner License Number is
. (Shop Owners must be currently licensed through
the Board of Barbers and Hairdressers.)
This apprenticeship will be held in compliance with the statutes and regulations set forth by the Board of Barbers and
Hairdressers. I am currently licensed as an instructor, Alaska License Number
, and have practiced for
the last three years at:
1.
Name of Shop
Address
Dates of Employment
2.
Name of Shop
Address
Dates of Employment
3.
Name of Shop
Address
Dates of Employment
Apprentices, shop owners, and instructors: Please be advised that in accordance with the statutes of postsecondary education
(AS 04.48), a shop owner may not charge the apprentice a fee to receive training.
If a shop owner charges the apprentice a fee for apprenticing, that shop owner may be acting as a school which requires
authorization from postsecondary education.
I CERTIFY under penalty of unsworn falsification that the information in this application is true and correct.
Signature of Instructor
Date
Mailing Address
City
State
Zip Code
WARNING
Alaska Statute 11.56.210 states that any person who knowingly or intentionally furnishes false or
fraudulent information in this application has committed a Class A misdemeanor.
08-4194a (Rev. 6/00)

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