Theatrical Employment Agency Self-Certification - Nyc Department Of Consumer Affairs
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15THEATRICAL EMPLOYMENT AGENCY
SELF-CERTIFICATION
Compliance with Theatrical Employment Agency Laws
This Self-Certification includes four parts:
PART I (general information)
PART II (information about Employment Agency Manager)
PART III (relevant laws and rules and checklists)
PART IV (signature and penalty for false statements)
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 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.
If the owner is not also the Employment Agency Manager, then the Employment Agency Manager must
complete and certify PART II.
PART I
Legal Name of Business:
DCA License Number,
if applicable:
Applicants for a new license do
not need to complete this field.
Business’s Trade or Doing-
Business-As (DBA) Name,
if applicable:
Employment Agency Address
(Building Number, Street Name,
Unit, e.g., Floor, Suite):
Revised 09/19/14
Page 1 of 15
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