Fillable ATHLETE AGENT APPLICATION INFORMATION FOR REGISTRATION (State of Alabama)

Fill Online, Printable, Fillable, Blank ATHLETE AGENT APPLICATION INFORMATION FOR REGISTRATION (State of Alabama) Form

Use Fill to complete blank online STATE OF ALABAMA (AL) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

ATHLETE AGENT APPLICATION INFORMATION FOR REGISTRATION (State of Alabama)

On average this form takes 60 minutes to complete

The ATHLETE AGENT APPLICATION INFORMATION FOR REGISTRATION (State of Alabama) form is 9 pages long and contains:

  • 0 signatures
  • 6 check-boxes
  • 239 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State of Alabama

BROWSE STATE OF ALABAMA (AL) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
ATHLETE AGENT
APPLICATION INFORMATION
FOR REGISTRATION
Checklist for completing registration process:
Submit proof of citizenship or lawfully present in the U.S (Copies Only)
Application should be typed or printed legibly. Application can be typed online.
Answer each question completely and attach additional sheets if necessary.
(Please do not leave any fields blank. If a question does not apply to you, type
Not Applicable (N/A))
Fee must accompany application: Fees are non-refundable. Make check/money order payable
to: Alabama Athlete Agents Commission—Fees are as follows:
$200 Initial Application Fee
$100 Initial based on a certificate of registration/licensure issued from another state
This office will accept the application and the registration/license from another state if the
application from the other state meets the following criteria:
(a) It was submitted in the other state within the previous six months and the applicant certifies that
the information contained in the application is current;
(b) It contains information substantially similar to or more compressive than that required on
Alabama’s application for registration as an athlete agent;
(c) It is signed by the applicant under penalty of perjury.
$100 Renewal License Fee
$100 Renewal based on a certificate of registration/licensure issued from another state
This office will accept the application and the registration/license from another state if the
application from the other state meets the following criteria:
(a) It was submitted in the other state within the previous six months and the applicant certifies that
the information contained in the application is current;
(b) It contains information substantially similar to or more compressive than that required on
Alabama’s application for registration as an athlete agent;
(c) It is signed by the applicant under penalty of perjury.
Application must be signed in ink and your signature must be notarized by a
Notary public with affixed seal
Mail application to: Alabama Athlete Agent Commission
Post Office Box 5616
Montgomery, AL 36103-5616
Physical address: Alabama Athlete Agent Commission
Alabama State House - Suite 226
11 South Union St.
Montgomery, AL 36130
Contact Info- Shemekwa Farrow (334-242-7224) or sport.code@sos.alabama.gov
Revised 03/2019
Page 1 of 8
S
TATE OF
A
LABAMA
OFFICE OF SECRETARY OF STATE
P.O. BOX 5616
MONTGOMERY, AL 36103-5616
www.sos.alabama.gov
JOHN H. MERRILL
SECRETARY OF STATE
A
PPLICATION FOR
R
EGISTRATION
AS AN ATHLETE AGENT
(VALID FOR TWO YEARS)
✓
Check One (Fees are non-refundable)
$200
INITIAL APPLICATION FEE
$100
RENEWAL LICENSE FEE
$100
INITIAL APPLICATION FEE
BASED ON REGISTRATION OR
LICENSE FROM ANOTHER STATE
$100
RENEWAL BASED ON
REGISTRATION/LICENSE
FROM ANOTHER STATE
A
PPLICATION
SHOULD BE TYPED OR PRINTED
PLEASE
DO NOT LEAVE ANY FIELDS BLANK. IF A QUESTION DOES NOT APPLY TO YOU, TYPE N/A.
Your
List Three (3) References
(Not Related to Applicant and Not Current Office Co-Worker) Must Be Current and Accurate
Name:
Last
First
Middle
Street
City
State
Zip Code
Home Address :
Principal Business Address :
Street
City
State
Zip Code
Name/Address of Affiliation (If applicable):
Street
City
State
Zip Code
Your
Your Home Telephone Number
Your
Your Work Telephone Number
Your
Your Mobile Telephone Number
Your
Electronic Communication (FAX number; email address; personal, business, or employer website(s)):
Name
Address
Telephone Number
Name
Address
Telephone Number
Name
Address
Telephone Number
Revised 03/2019
Page 2 of 8
Answer All Questions Completely
G
ENERAL
Are you a U.S. Citizen?
In accordance with Alabama Code § 31
-13-29, please submit a copy of one of the following with your application:
(1) A driver's license or nondriver's identification card issued by the Alabama State Law Enforcement Agency or
the equivalent governmental agency of another state within the United States, provided that
the governmental agency of another state within the United States requires proof of lawful presence in
the United States as a condition of issuance of the driver’s license or nondriver's identification card.
(2) A birth certificate indicating birth in the United States or one of its territories.
(3) Pertinent pages of a United States valid or expired passport identifying you and your passport number, or
your United States passport.
(4) United States naturalization documents or the number of the certificate of naturalization.
(5) Other documents or methods of proof of United States citizenship issued by the federal government pursuant to the
Immigration and Nationality Act of 1952, as amended.
(6) Bureau of Indian Affairs card number, tribal treaty card number, or tribal enrollment number.
(7) A consular report of your birth abroad of a citizen of the United States of America.
(8) A certificate of citizenship issued by the United States Citizenship and Immigration Services.
(9) A certification of report of birth issued by the United States Department of State.
(10) An American Indian card, with KIC classification, issued by the United States Department of Homeland Security.
(11) Final adoption decree showing your name and United States birthplace.
(12) An official United States military record of service showing your place of birth in the United States.
(13) An extract from a United States hospital record of birth created at the time of your birth indicating the place of birth in
the United States.
(14) AL-Verify.
(15) A valid Uniformed Services Privileges and Identification Card.
(16) Any other form of identification that the Alabama Department of Revenue authorizes, through an administrative rule
promulgated pursuant to the Alabama Administrative Procedure Act, to be used to demonstrate or confirm a person’s
United States citizenship or lawful presence in the United States, provided that the identification requires proof of
lawful presence in the United States as a condition of issuance.
If not a citizen, are you lawfully present in the United States?
In accordance with Alabama Code
§ 31-13-3, please submit a copy of one of the following with your application:
a) A valid, unexpired Alabama driver’s license.
b) A valid, unexpired Alabama nondriver identification card.
c) A valid tribal enrollment card or other form of tribal identification bearing a photograph or other biometric identifier.
d) Any valid United States federal or state government issued identification document bearing a photograph or other biometric
identifier, including a valid Uniformed Services Privileges and Identification Card if issued by an entity that requires proof of lawful
presence in the United States before issuance.
e) A foreign passport with an unexpired United States Visa and a corresponding stamp or notation by the United States Department of
Homeland Security indicating the bearer’s admission to the United States.
f) A foreign passport issued by a visa waiver country with the corresponding entry stamp and unexpired duration of stay annotation or
an I-94W form by the United States Department of Homeland Security indicating the bearer’s admission to the United States.
Yes
No
N/A
Yes
No
Revised 03/2019
Page 3 of 8
E
DUCATION
:
HIGH SCHOOL GRADUATE OR GED?
/ / / /
/ / / /
/ / / /
/
/
/ /
/
/
/ /
/
/
/ /
E
MPLOYMENT: (check one) I am currently
/ /
/ /
Yes
No
Name and location of high school attended:
From
(Mo) (Yr)
To
(Mo) (Yr)
Did you
Graduate?
Date of
Graduation
Yes
No
To
(Mo) (Yr)
Yes
No
From
(Mo) (Yr)
Did you
Graduate?
Date of
Graduation
Name and location of Colleges and Universities attended:
From
(Mo) (Yr)
If your answer is “Yes” please state all names used and when
so used: (If more space is needed use reverse side.)
Name of your spouse’s Employer:
Street Address
To
(Mo) (Yr)
City
State
Zip Code
Does your spouse have any business relationship with any
professional sport or professional sports team?
Did you
Graduate?
Yes
No
If your answer is “Yes” please provide details of said relationship:
Your Date of Birth:
Date of
Graduation
(Mo)
(Day)
(Yr)
Place of Birth: (City and State)
If a married woman, please state your maiden name:
No
Yes
Yes
No
Name and location of Law or Other Graduate School Attended:
From
(Mo) (Yr)
To
(Mo) (Yr)
Did you
Graduate?
Date of
Graduation
Yes
No
Yes
No
Yes
No
Self-Employed
Employed
Name and Address of Employer:
Name
Street Address
If Self-Employed complete the following:
City
Nature of Business
Your Title/Position
Telephone No.
Starting Date
Name
Street Address
City
State
Zip Code
State
Zip Code
Nature of Business
Telephone No.
Starting Date
Have you ever been known by any other name or surname?
Name of your spouse:
Revised 03/2019
Page 4 of 8
(1) Name of Previous Employer: (Last 5 years immediately
preceding date of application. Use additional sheets as necessary)
(2) Name of Previous Employer: (Last 5 years immediately preceding
date of application. Use additional sheets as necessary)
/ /
/ /
/ /
/ /
10
B
USINESS
/C
ORPORATION
:
If a corporation employs you as an athlete agent then provide the names and addresses of the officers,
directors, and any shareholders of the corporation having an interest of five percent (5%) or greater.
(Use additional sheets if necessary)
If your business as an athlete
agent is not a corporation then provide the names and addresses of all
partners, members, officers, managers, associates or profit
-sharers or directly or indirectly holds an equity
interest of five percent (5%) or greater
of the business.
(Use additional sheets if necessary
)
Please list each social media account and username with which you or your business or employer are
affiliated:
Have you or any person named in question #10 above ever pleaded guilty or no contest to, been convicted,
has charges pending
, would be a crime involving moral turpitude or a felony committed in this state?
If “Yes” then identify the crime, law enforcement agency involved, and
if applicable the date of conviction
and the fine or penalty imposed:
Address
Address
Address
Address
Name
Name
Name
Name
No
Yes
Street Address
City
State
City
State
Zip Code
Zip Code
Start Date
Your Title/Position
Start Date
Ending Date
Ending Date
Employer
Street Address
Your Title/Position
Revised 03/2019
Page 5 of 8
Has your occupational or professional conduct or that of any person named in question #10 above ever
resulted in the imposition of a sanction, suspension,
disciplinary action, or declaration of ineligibility to
part
icipate in an interscholastic, intercollegiate, or professional athletic event regarding a student
athlete or
a sanction
from an educational institution?
If “Yes, please provide date and full explanation:
Have you or any person named in question #10 above, within 15 years before the date of application, been
a defendant or respond
ent in a civil proceeding, including a proceeding seeking an adjudication of legal
incompetence?
If “Yes” provide d
ate and full explanation of each proceeding:
Have you or any person named in question #10 above had an unsatisfied judgement or a judgement of
continuing effect, including alimony or a domestic order in the nature of child support, which is not current
at the date of this application?
If “Yes” provide date and full explanation:
Have you or any person named in question #10 above, within 10 years before the date of application, been
adjudicated bankrupt or been
the owner of a business that was adjudicated bankrupt?
If “Yes” provide date and full explanation:
No
Yes
No
Yes
No
Yes
No
Yes
Revised 03/2019
Page 6 of 8
Has there been any administrative or judicial determination that you or any person named in question #10
above
made a false, misleading, deceptive, or fraudulent representation?
If “Yes” provide date and full explanation:
List each state in which you are currently registered as an athlete agent or have applied to be registered as
an athlete agent.
Are you certified or registered by a professional league or players association?
If “Yes” please list:
/ /
/ /
Please list dates pertaining to the certification or registration, including application denial, suspension, revocation, refusal to
renew, withdrawal, termination, reprimand, or censure.
Has there ever been any denial of an application for, suspension or revocation of, refusal to renew, or
abandonment of,
the registration or licensure of yourself, or any person who is named in question #10
above as an athlete agent in any state?
If “Yes” please give a description:
No
Yes
No
Yes
Name of League/Association
Date of Certification/Registration
Date of Expiration
No
Yes
Revised 03/2019
Page 7 of 8
Please list a description of the status of any application by yourself or any person named in question #10,
for a state or federal business, professional, or occupational license, other than as an athlete agent, from a
state or federal agency, including an
y denial, refusal to renew, suspension, withdrawal, or termination of
the license and any reprimand or censure related to the license:
P
RACTICAL
E
XPERIENCE
/F
ORMAL
T
RAINING AS
A
THLETIC
A
GENT
:
Provide in detail a description of your formal training, practical experience, and educational background
relating to your professional activities as an athletic agent:
(attach additional sheets if necessary)
List any professional or occupational licenses, registrations, or certifications held within the last 5 years.
Revised 03/2019
Page 8 of 8
P
ROFESSIONAL
S
PORTS
E
XPERIENCE
:
List the name, sport and last known team for each individual for whom you have acted as an athlete agent
during the five (5) years preceding
the submission of this application or, if the individual is a minor, the
name of the parent or guardian of the minor
:
O
ATH
/A
FFIRMATION
:
In submitting this application for registration as an athlete agent in the state of Alabama, I do hereby swear or
affirm that I have reviewed the information contained herein and on any attachments hereto, and that such
information is correct and true to the best of my knowl
edge. I understand that giving false information in this
application constitutes cause for denial or revocation of my application and could subject me to criminal
prosecution for perjury. I acknowledge that I have a duty and I agree to update and correct
this information as
it changes. I am aware that, should an investigation at any time disclose any such misrepresentation or
falsification, my application could be rejected or my registration revoked and that I may be subject to
prosecution in the state of Alabama.
State of )
County of )
month
year
Signature of Applicant
Sworn and subscribed to before me this _______ day
of ______________________, ______________.
Date
Notary Public Signature
Notary Seal
My Commission Expires: __________________________
Name of Athlete
F
OR
D
EPARTMENT
U
SE
O
NLY
Sport
P
ERMIT
N
O
.
D
ATE
P
ERMIT
I
SSUED
Professional Sports Team
Revised 03/2019
/
/
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

ATHLETE AGENT APPLICATION INFORMATION FOR REGISTRATION (State of Alabama)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document