Form Cs-043 - Application For Salesman'S License (Page 2 of 3) in pdf

Motor Vehicle Administration

CS-043 (02-16)

6601 Ritchie Highway, N.E.

Glen Burnie, Maryland 21062

Application for Salesman’s License

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Type of License:

New

Transfer

Corrected

Duplicate

Name of Applicant: Last ______________________________________________First________________________________________ Middle _________________________________

Street Address (Home) __________________________________________ City _______________________________State _________________ Zip Code _______________________

Date of Birth _________________________________Driver’s License Number ________________________________________________________ State _______________________

Social Security Number ________________________________________________________ Home Phone Number ______________________________________________________

Dealer’s License Number _____________________________________________________________________ Email ______________________________________________________

Full Name of Dealership (including corporate name) __________________________________________________________________________________________________________

Dealer Street Name ______________________________________________________________________________________________________________________________________

City ________________________________________________ County ______________________________________State _________________ Zip Code _______________________

Dealership Contact (full name) ______________________________________________ Title _______________________________ Phone Number ____________________________

Workers Compensation Company Name _________________________________________________________ Policy Number____________________________________________

Certification of Dealer: It is certified that the above named person is employed and duly appointed as a salesman by the undersigned, a licensed motor vehicle dealer. I/

we assumed responsibility for making certain the sales applicant does not sell vehicles until this application has been approved and a license has been issued.

Important Notice to Dealership: This is not a license to sell vehicles. This form must be approved by the MVA. Once approved, the employing dealer will receive a

computer license authorization, which the salesperson will take to a MVA office. He/she will pay the appropriate fee, have their photo taken, and be issued a photo vehicle

sales license period. The sales applicant may not sell vehicles until the sales license is issued.

Signature of Authorized Representative _____________________________________________________ Title _________________________ Date ____________________________

Printed Name ___________________________________________________________

Background Questions for Applicant

Yes No

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1. Have you ever applied for or been licensed as a salesman or a dealer in this or any other state?

If yes, please indicate Type of License: __________________________________License Number ______________________________________________________

Business Name: ________________________________________________State: ____________________ Expiration: ______________________________________

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2. Do you currently hold a dealer, salesman, or title service agent license issued Maryland or any other state?

If yes, please indicate Type of License: __________________________________License Number ______________________________________________________

Business Name: ________________________________________________State: ____________________ Expiration: ______________________________________

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3. Are any administrative actions, including suspension, revocation, refusal, or fines pending against any license you have held?

If yes, give a detailed statement on a separate sheet.

If yes, please indicate Type of License: __________________________________License Number ______________________________________________________

Business Name: _____________________________________ State:_________________ Expiration: ___________________ Date of Action ____________________

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4. Have you ever been convicted of a crime other than a traffic violation? If yes, submit dispositions of charges from the court giving a detailed statement

of charges, include dates and circumstances surrounding the incidents. And if you are currently or have been on parole or probation in the past, submit a

statement from your parole or probation officer. This statement must indicate the terms and your current compliance with the terms of your probation.

I certify, under penalty of perjury, that the statements made herein are true and correct to the best of my knowledge, information and belief. I also certify that

I am familiar with the Motor Vehicle licensing laws and other laws of Maryland governing the conduct of motor vehicle salesman and will cooperate with the

Motor Vehicle Administration in the enforcement of the applicable provisions of the Transportation Article and the agency regulations and that I will engage in

the business of selling motor vehicles or trailers only for the dealers for which the Dealer Licensing has so authorized.

Full Signature of Applicant __________________________________________________________________________ Date _________________________________________________

For MVA Use Only

Application ________ Approved ________ Rejected

Representative Name __________________________________________________ Date _______________________

For more information, please call: 410-768-7000 (to speak with a customer agent).

TTY for the hearing impaired: 1-800-492-4575. Visit our website at: