Theatrical Employment Agency Renewal Self-Certification - Nyc Department Of Consumer Affairs

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THEATRICAL EMPLOYMENT AGENCY
RENEWAL SELF-CERTIFICATION
Compliance with Theatrical Employment Agency Laws
Note: This Self-Certification is for agencies that place or attempt to place artists in theatrical
engagements only. If you place or attempt to place job applicants in any other type of employment,
you must complete the “Employment Agency Renewal Self-Certification” instead.
If you have not previously submitted to DCA a Theatrical Employment Agency Self-Certification or
your agency has undergone a change in ownership, you must complete the full “Theatrical
Employment Agency Self-Certification” instead.
The owner (e.g., sole proprietor, general partner, director, corporate officer, or shareholder owning 10%
or more of company stock) of your agency must complete this form.
Legal Name of Business:
Business’s Trade or Doing-
Business-As (DBA) Name, if
applicable:
DCA License Number:
Employment Agency Address
(Building Number, Street Name,
Unit, e.g., Floor, Suite):
Name of Owner
(e.g. sole proprietor, general
partner, director, corporate
officer, or shareholder owning
10% or more of company
stock):
3/25/2016
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