Occupational and Business Licensing
555 Wright Way
Carson City, NV 89711-0100
CERTIFICATE OF EMPLOYMENT
Please type or print in ink. FEES
Salesman New $
Inspector Renewal $
Class: Transfer $
Drive School Instructor Behind the Wheel
CDL Non CDL General Classroom
DUI School Instructor General Classroom Under 18
Traffic Safety School Instructor Trainee
Full Legal Name Occupational License No.
Mailing Address City State Zip
Physical Address City State Zip
Phone No: ( )
Social Security No - - Date of Birth Sex
Height Weight Hair Eyes
I certify under penalty of perjury that all information contained in this application is true and correct.
Employee’s Signature Date:
Business Name Business License No.
City State Zip Phone No:
Authorized Representative's Name and Title (Print) :
Authorized Representative’s Signature: