Minnesota > Statewide > Department Of Commerce > Athlete Agent Registration
Athlete Agent Registration Application - Minnesota
| Athlete Agent Registration Application Form. This is a Minnesota form and can be used in Athlete Agent Registration Department Of Commerce Statewide . |
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A. TYPE OF APPLICATION AND FEE New Registration Reciprocal Registration FEE: $550* FEE: $550* Instructions: 1. Submit a copy of your license showing that you are currently licensed as an athlete agent in another state Instructions: 2. Submit a copy of the license application you submitted to obtain the athlete agent license. · If your previous application was signed more than 6 months prior to your application for a Minnesota Complete, sign and submit license, you must complete the Minnesota license application form. this application form. · If your previous application did not include all the information required in the Minnesota application, you must complete the Minnesota license application form. 3. Sign and submit the certification in the Minnesota application form. *In accordance with Minn. Stat. §16E.22, this fee includes a 10% OET surcharge, which is being collected on behalf of the Minnesota Office of Enterprise Technology to fund a statewide electronic licensing system. B. GENERAL INFORMATION Last Name (please print or type) Residence Address City Date of Birth (mo/day/yr) State Residence Telephone Number ( ) Zip Code Social Security Number First Middle C. APPLICANT'S PRINCIPAL PLACE OF BUSINESS Name of Principal Place of Business Address City State (If you work alone, list your own name and address.) Zip Code Business Telephone Number ( ) Business Structure of Principal Place of Business (Check one and submit the required attachments): Individual Proprietor · Attach a completed "BCA" form. Corporation · Attach completed "Disclosure of Owners, Partners, Officers" form. · Attach a completed "BCA" form for each individual listed on the "Disclosure of Owners, Partners, Officers" form. Partnership · Attach completed "Disclosure of Owners, Partners, Officers" form. · Attach a completed "BCA" form for each individual listed on the "Disclosure of Owners, Partners, Officers" form. Other (Specify: _________________________________) · Attach completed "Disclosure of Owners, Partners, Officers" form. · Attach a completed "BCA" form for each individual listed on the "Disclosure of Owners, Partners, Officers" form. D. CREDENTIALS PRIOR CLIENTS Has the applicant acted as an athlete agent during the five (5) years prior to this application? Yes No If yes, provide the name, sport and team for each individual for whom you acted as an athlete agent during the 5 years prior to this application (attach additional sheet if necessary): Athlete Name: __________________________________________ Sport: ________________________ Last Known Team ______________________ Athlete Name: __________________________________________ Sport: ________________________ Last Known Team ______________________ Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com EMPLOYMENT HISTORY Provide employment history for the five (5) years preceding the date of this application. (Attach additional pages if necessary) Employer Address Dates of Employment From ______/______/______ To ______/______/______ Employer Address Dates of Employment From ______/______/______ To ______/______/______ Employer Address Dates of Employment From ______/______/______ To ______/______/______ DESCRIPTION OF DUTIES City DESCRIPTION OF DUTIES City DESCRIPTION OF DUTIES City Position Title State Zip Position Title State Zip Position Title State Zip FORMAL TRAINING Does the applicant have formal training as an athlete agent? Yes No If yes, when was formal training obtained? From ___________/___________/____________ to ___________/___________/___________ Name of training facility: ____________________________________________________ Location: ___________________________________ Provide a description of the formal training: PRACTICAL EXPERIENCE Does the applicant have practical experience as an athlete agent? Yes No If yes, when was practical experience obtained? From ___________/___________/____________ to ___________/___________/___________ At what business was practical experience obtained: ________________________________________ Location: ___________________________ Provide a description of the practical experience: EDUCATIONAL BACKGROUND Does the applicant have educational background related to activities as an athlete agent? Yes No If yes, when was educational background obtained? From __________/__________/__________ to __________/__________/__________ Name of educational facility: ____________________________________________________ Location: ___________________________________ Provide a description of the educational background: REFERENCES Provide three (3) references. (Do not include the names of any relatives.) Name:_______________________________________________________________________________ Telephone _(______)________________ Address:_______________________________________________________________City ______________________State _______ Zip__________ Name:_______________________________________________________________________________ Telephone _(______)________________ Address:_______________________________________________________________City ______________________State _______ Zip__________ Name:_______________________________________________________________________________ Telephone _(______)________________ Address:_______________________________________________________________City ______________________State _______ Zip__________ Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com All applicants must answer the following questions. · · · 1. For individual Applicants, answer YES if the Applicant has ever: For partnership Applicants, answer YES if any of the Applicant's partners have ever: For corporate or LLC or other business entity Applicants, answer YES if any of the Applicant's officers, directors, shareholders, LLC governors, managing members or associates have ever: YES NO 2. 3. 4. 5. Been convicted of a crime that, if committed in this state, would be a felony or a crime involving moral turpitude? If yes, you must attach: a) a written statement, signed and dated by the convicted individual, explaining the circumstances of each incident, b) a copy of the charging document, c) a copy of the official document which establishes the resolution of the charges or any final judgment, and d) if currently on probation, attach letter from probation officer stating individual's compliance with terms of probation. Been the subject of any administrative or judicial determination that the person has made a false, misleading,
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