Renewal Application For License To Operate Employment Agency - South Carolina Secretary Of State

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SOUTH CAROLINA
SECRETARY OF STATE
E
A
MPLOYMENT
GENCY
R
A
L
O
ENEWAL
PPLICATION FOR
ICENSE TO
PERATE
Filing Instructions
 The filing fee for this renewal application is $100.
This application must be completed in its entirety. If there are any questions not answered, signatures
missing or required documents not attached, this form will be returned for correction.
 Please contact our office with any questions regarding this form at 803-734-0367.
 This application must be mailed to:
South Carolina Secretary of State, Employment Agencies, 1205 Pendleton St., Ste. 525, Columbia, SC 29201
1. Business Contact Information:
a. Full Name
b. Phone Number
c. Email Address
2. Business Entity Information:
a. Business Name
b. Trade Name or DBA (if applicable)
c. Physical Location of Business (Street, City, Zip Code, County)
d. Mailing Address of Business (If different from above)
e. Phone Number
f. Website
3. Entity’s Type of Ownership:
____ Sole Proprietor ____ Partnership ____ Corporation, Association, or Society
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
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