Fillable Application for Certificate of Recognition (Human Trafficking Prevention (Texas Secretary of State)

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Application for Certificate of Recognition (Human Trafficking Prevention (Texas Secretary of State)

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1
Revised 08/2017
Application for Certificate of Recognition
(Human Trafficking Prevention Business Partnership Program)
The attached application, including the information provided in the application, is a public record and subject to
public access and disclosure. Do not include information that may be confidential or a trade secret.
Commentary
The Human Trafficking Prevention Business Partnership program as provided by Section 405.023 of the
Texas Government Code and the secretary of state’s administrative rules found in 1 Texas Administrative
Code Chapter 90, recognizes that corporations and private entities can contribute to the efforts of federal,
state, and local officials engaged in combatting human trafficking and in prosecuting human trafficking
crimes. This application process is designed to identify and recognize those corporations and private
entities that have implemented zero tolerance policies toward human trafficking and have taken voluntary
steps to promote public awareness of human trafficking.
Any corporation or private entity that engages in a for-profit activity may submit an application for
participation in the partnership and for a certificate of recognition. A corporation is defined by rule as a
domestic or foreign for-profit corporation, limited partnership, limited liability company, professional
association, or cooperative association that is governed under the Texas Business Organizations Code,
federal law, or the law of another state or nation. A private entity includes a bank, trust company, savings
and loan association, insurance company, railroad company, or other organization that engages in a for-
profit activity through its employees.
A certificate of recognition issued to an eligible participating corporation or private entity is valid for three
years and can be renewed for an additional term by the participating e ntity. There is no processing fee for
making an application.
Instructions for Form
A document on file with the secretary of state is a public record subject to public access and
disclosure. When providing address or telephone information, use a business or post office
box address rather than a residence address if privacy concerns are an issue.
• Applicant Information: Provide the full legal name of the applicant and its principal office address.
The principal office address does not need to be in Texas. The contact point is the individual to whom
any correspondence may be addressed regarding the application or documentation provided. The
contact point is not required to be the person who signed the application.
• Business Information: Completion of this section is not required, but optional. However, the
information provided may be useful to the secretary of state when developing a database of best
practices for combatting and preventing human trafficking within certain industries or businesses.
• Attachments: If the space provided is not sufficient, provide additional information or documentation
as a separate attachment to the form. Do not include digital, video or electronic attachments. If
applicant provides employee training on human trafficking or other information in a digital or
electronic format, a print-out or transcript of the material should be provided.
• Execution: The application must be signed by a person who is authorized to sign on behalf of the
applicant. Generally, a corporate officer is authorized to sign on behalf of a corporate entity.
• Delivery Instructions: The completed form may be mailed to P.O. Box 13193, Austin, Texas 78711-
3193; or delivered to the James Earl Rudder Office Building, 1019 Brazos, Austin, Texas 78701. The
secretary of state will issue a certificate of recognition on filing a completed and approved application.
2
T
his space reserved for office use
APPLICATION FOR
CERTIFICATE OF
RECOGNITION
Rev
. 08/2017
Submit to:
SECRETARY OF STATE
Registrations Unit
P O Box 13193
Austin, TX 78711-3193
512-475-0775
512-475-2815 - Fax
The undersigned applicant seeks to participate in the Human Trafficking Prevention Business
Partnership program established by §405.023 of the Government Code and requests recognition for its
contributions to the efforts of federal, state, and local officials engaged in combatting human trafficking
and in prosecuting human trafficking crimes. The voluntary steps and measures taken by the applicant
to prevent and combat human trafficking, as demonstrated by the information and documentation
provided, qualify the applicant for membership in the partnership and for a certificate of recognition.
Applicant Information
1. Business Name:
Provide the full legal name of corporation or private entity
2. Address:
Street City State Zip Code
3. Contact Point:
First Name Last Name Job Title
Contact Address: Same as above Contact's mailing address is different and shown below:
Street City State Zip Code
Work Phone:
Business Information (optional)
Type of Business: Retail Service Manufacturing
Average Number of Employees: Number of Locations in Texas:
Markets Served by Applicant: Local National International
Briefly Describe Applicant's Main Products/Services:
Eligibility
4. Partnership Promotion & Awareness:
Has applicant either notified its employees that the entity is seeking a certificate of recognition as a
member of the partnership or does applicant agree to notify employees if a certificate of
recognition is granted?
No Yes
Has applicant either notified its business partners that the entity is seeking a certificate of
recognition as a member of the partnership or does applicant agree to notify its business partners if a
certificate of recognition is granted?
No Yes
Not Applicable
3
Eligibility
Complying with all applicable federal and state human trafficking laws and regulations?
No Yes Not Applicable
Assessing and examining the business's supply lines, supplies, other inputs, and business related
facilities to determine that they are free from human trafficking and taking appropriate action to
address negative findings?
No Yes Not Applicable
Eligibility
5.5. Has applicant adopted a Zero Tolerance Policy towards human trafficking that includes:
Complying with all applicable federal and state human trafficking laws and regulations?
Not Applicable
No Yes
Assessing and examining the business's supply lines, supplies, other inputs, and business related
facilities to determine that they are free from human trafficking and taking appropriate action to
address negative findings?
No
C
reating a housing plan (if the corporation or private entity provides or arranges housing) that
ensures compliance with applicable host country requirements?
No Yes Not Applicable
Prohibiting employees, agents, or subcontractors from withholding the identity or immigration
documents, such as a passport or driver's license, from a worker?
No Yes Not Applicable
Yes N
ot Applicable
No Yes
Prohibiting employees, agents, or subcontractors from withholding the identity or immigration
documents, such as a passport or driver's license, from a worker?
Not Applicable
Procedures to prevent agents and subcontractors at any tier and at any dollar amount from engaging
in trafficking in persons, and to monitor, detect, and terminate any agents and subcontractors who
engage in, or who have employees who engage in, such activities?
No Yes Not Applicable
A prohibition against the expenditure of any business funds for the purpose of patronizing a
business that is part of the commercial sex industry or using any business resources to
engage in activities related to the commercial sex industry?
No Yes Not Applicable
Provide additional supporting documentation, as necessary:
6. Has applicant taken measures to ensure compliance with the Zero Tolerance Policy, including:
Implementing a mandatory human trafficking awareness training for all employees that includes
the actions that will be taken against employees for violations?
No Yes
Provide information about the training used and attach copies, if available:
Establishing a policy and point of contact for employees to report possible violations without fear
of retaliation, including through a hotline number and e-mail address, and to ensure that any
violations get reported to the proper law enforcement agency and the Texas Department of Family
and Protective Services?
No
Yes
Provide information about the training used and attach copies, if available:
Establishing a policy and point of contact for employees to report possible violations without fear
of retaliation, including through a hotline number and e-mail address, and to ensure that any
violations get reported to the proper law enforcement agency and the Texas Department of Family
and Protective Services?
No
Yes
Providing information to employees about resources for providing assistance to victims of human
trafficking?
No Yes
Provide additional information or documentation, as needed:
7. Has applicant participated in any human trafficking public awareness or education campaigns within
the last twelve months?
No Yes If yes, list the date of the campaign(s).
Describe the campaign and how it raised awareness of human trafficking within applicant’s
community or supported federal, state, or local efforts to combat/prosecute human trafficking. Attach
any additional documentation as needed.
Describe applicant’s participation in the campaign. Attach any additional documentation as
needed.
8. By seeking membership in the Human Trafficking Prevention Business Partnership program,
applicant agrees to share its best practices in combatting human trafficking. Describe below
applicant’s best practices. Attach additional supporting documentation as needed.
4
(seal)
5
Certification of Applicant
I certify that I have reviewed the preceding statements and any attached supporting documentation
provided, and to the best of my knowledge, the information provided is true, accurate, and complete. I
also certify that I have the authority to execute this application on behalf of the applicant.
Execution
Date:
Signature of Authorized Person
Printed or typed na
me and capacity/title
State of _______________________ )
County of )
Sworn to and subscribed before me this day of , 20
Notary Public Signature
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Application for Certificate of Recognition (Human Trafficking Prevention (Texas Secretary of State)

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Completed 11 February 2021

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