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

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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
5. Have any of the applicants listed above previously held or applied, whether granted or denied, for a private
personnel placement service license within the United States or its possessions or territories?
a.
___ No
___ Yes If yes, was the private personnel placement service license ever denied or revoked?
___ No ___ Yes If yes, please attach an explanation to this application.
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