Employment Agency Self-Certification - Nyc Department Of Consumer Affairs Page 8
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20Receipts (Check A or B.)
A. I will use DCA’s model receipt as my agency’s receipt and give a receipt to each job applicant
who pays a fee as confirmation of payment. The model receipt is available for download at
nyc.gov/BusinessToolbox. I am responsible for using the most current version of this receipt, and
I will regularly check DCA’s website for updates.
B. I will not use DCA’s model receipt, but will give each job applicant who pays a fee a receipt
that is substantially similar to DCA’s model receipt and will include all of the following:
The word “Receipt” written or printed clearly at the top AND
Name of the job applicant AND
Name, address, and DCA license number of my agency AND
Date and amount of the fee AND
Reason for the fee AND
Signature, printed name, and title of the person receiving the deposit, fee, or other charge
on behalf of my agency
Maintenance of Contracts and Receipts
I will maintain at my agency and have available for inspection by DCA all completed contracts and
receipts I issued for three years.
Section 5: Application Forms
GBL Section 187(3)
6 RCNY Sections 1-05, 1-16, and 5-248
If my agency uses a job application form, I understand that it must be a separate document that I
cannot combine with my agency’s contract. I will give a copy of the completed job application form to
each job applicant who applies for my services.
My agency’s job application form will include all of the following:
The words “Application Form” written or printed clearly at the top AND
Name of the job applicant AND
Name, address, telephone number, and DCA license number of my agency AND
The word “agency”
My agency’s job application form will not directly or indirectly inquire about a job applicant’s age,
race, creed, color, national origin, religion, sex, disability, predisposing genetic characteristics, marital
status, or status as a victim of domestic violence, sex offence, or stalking. If the application form directly
or indirectly inquires about any of this information, the form will also clearly state how the information
relates to a legitimate job qualification.
I will maintain at my agency and have available for inspection by DCA all completed job application
forms I issued for three years.
Section 5 does not apply to my agency because my agency will not use an application form.
Revised 09/19/14
Page 8 of 20
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