Employment Agency Self-Certification - Nyc Department Of Consumer Affairs Page 3
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20PART II
Information about Employment Agency Manager
Employment Agencies must have an Employment Agency Manager who is responsible for directing and
operating the placement activities of the employment agency. This person can be the owner. The person
(either the owner or another individual) who will act as the agency’s manager must complete and
certify Part II.
The Department of Consumer Affairs (DCA) will consider this Self-Certification incomplete if you
do not complete and certify PART II.
Practical Experience: State your experience as a placement employee, vocational counselor, or in related
activities that indicate your competence to operate the placement activities of this agency. Attach
additional papers as necessary.
Name of
Address
Telephone
Start/End Dates
Position
Employer
and Duties
Revised 09/19/14
Page 3 of 20
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