Initial Application For License To Operate Employment Agency - South Carolina Secretary Of State Page 2

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4. Application Made By (complete the appropriate section):
a. Sole Proprietor— (Application must be made by the owner.)
Name
Address (Street, City, Zip Code)
Prior Business or Occupation of the Applicant
b. Partnership— (Application must be made by all of the partners; attach a separate sheet if necessary.)
Name
Address (Street, City, Zip Code)
% Owned
Prior Business or Occupation of the Applicant
Name
Address (Street, City, Zip Code)
% Owned
Prior Business or Occupation of the Applicant
c. Corporation, Association, or Society— (Application must be made by the president, vice-president,
secretary, and treasurer and by a person owning twenty percent or more of the stock.)
President
Name
Address (Street, City, Zip Code)
% Owned
Prior Business or Occupation of the Applicant
Vice-
Name
Address (Street, City, Zip Code)
% Owned
President
Prior Business or Occupation of the Applicant
Secretary
Name
Address (Street, City, Zip Code)
% Owned
Prior Business or Occupation of the Applicant
Treasurer
Name
Address (Street, City, Zip Code)
% Owned
Prior Business or Occupation of the Applicant
Stockholder
Name
Address (Street, City, Zip Code)
% Owned
Prior Business or Occupation of the Applicant
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