"Credit Counselor Initial Application" - South Carolina

Credit Counselor Initial Application is a legal document that was released by the South Carolina Department of Consumer Affairs - a government authority operating within South Carolina.

Form Details:

  • Released on November 1, 2021;
  • The latest edition currently provided by the South Carolina Department of Consumer Affairs;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the South Carolina Department of Consumer Affairs.

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STATE OF SOUTH CAROLINA
DEPARTMENT OF CONSUMER AFFAIRS
CREDIT COUNSELOR
INITIAL APPLICATION
Mailing Address
Street Address
S.C. Code Ann. § 37-7-101 et seq. & Regulation 28-700
P.O. Box 5757
293 Greystone Boulevard, Ste. 400
Columbia, SC 29250-5757
(803) 734-4251 |
www.consumer.sc.gov
| (803) 734-4200
Columbia, SC 29210-8004
Application can be filed online. Visit
www.consumer.sc.gov
and click on “online filing.”
IMPORTANT: Print legibly or type information requested on this form in its entirety. Illegible or faxed applications will not
be accepted. Incomplete information could result in delay or denial of your application. When completing the application,
attach additional pages as necessary. If any of the information on this form changes, submit an Application Update/Change
Form to the Department.
*Application is not complete without the filing fees. Make checks payable to S.C. Department of Consumer Affairs.*
GENERAL INFORMATION
Business Name
(Headquarters/Main)
Business License No.
DBA
Nickname/Previous Name
Full Legal Name
(if any)
Business Title
Percentage of Ownership
SSN
Date of Birth
Employment Address
City
State
Zip
Residential Address
City
State
Zip
Work Phone No.
(
)
-
Home Phone No.
(
)
-
E-mail Address
EDUCATIONAL BACKGROUND.
(Attach additional pages as necessary.)
SCHOOL
ADDRESS
DATES ATTENDED
DEGREE EARNED
Credit Counselor Initial Application
MUST BE RENEWED BY DECEMBER 1
ST
EACH YEAR
Revised 11/2021
Page 1 of 3
STATE OF SOUTH CAROLINA
DEPARTMENT OF CONSUMER AFFAIRS
CREDIT COUNSELOR
INITIAL APPLICATION
Mailing Address
Street Address
S.C. Code Ann. § 37-7-101 et seq. & Regulation 28-700
P.O. Box 5757
293 Greystone Boulevard, Ste. 400
Columbia, SC 29250-5757
(803) 734-4251 |
www.consumer.sc.gov
| (803) 734-4200
Columbia, SC 29210-8004
Application can be filed online. Visit
www.consumer.sc.gov
and click on “online filing.”
IMPORTANT: Print legibly or type information requested on this form in its entirety. Illegible or faxed applications will not
be accepted. Incomplete information could result in delay or denial of your application. When completing the application,
attach additional pages as necessary. If any of the information on this form changes, submit an Application Update/Change
Form to the Department.
*Application is not complete without the filing fees. Make checks payable to S.C. Department of Consumer Affairs.*
GENERAL INFORMATION
Business Name
(Headquarters/Main)
Business License No.
DBA
Nickname/Previous Name
Full Legal Name
(if any)
Business Title
Percentage of Ownership
SSN
Date of Birth
Employment Address
City
State
Zip
Residential Address
City
State
Zip
Work Phone No.
(
)
-
Home Phone No.
(
)
-
E-mail Address
EDUCATIONAL BACKGROUND.
(Attach additional pages as necessary.)
SCHOOL
ADDRESS
DATES ATTENDED
DEGREE EARNED
Credit Counselor Initial Application
MUST BE RENEWED BY DECEMBER 1
ST
EACH YEAR
Revised 11/2021
Page 1 of 3
EMPLOYMENT BACKGROUND
. Describe your employment for the last ten (10) years, starting with your current position.
Account for all time, including periods of unemployment for more than one (1) month. (Attach additional pages as necessary.)
NAME OF
EMPLOYER,
DATES OF
REASON FOR
POSITION HELD
NAME OF OWNER
ADDRESS &
EMPLOYMENT
LEAVING
PHONE NUMBER
Description of Qualifications
.
Describe the business credentials which qualify you to conduct business pursuant to the South Carolina
Consumer Credit Counseling Act, in addition to a description of your character. (Attach additional pages as necessary.)
QUESTIONS
1.
Have you been convicted of a felony within the past ten (10) years?
Yes
No
If “Yes,” provide details about the offense, including conviction date, court, and penalty. Also
attach a certified copy of the Criminal Docket Sheet and the Presentence Investigation Report.
2.
Have you been convicted of an offense involving breach of trust, moral turpitude or dishonest
Yes
No
dealings within the past ten years?
If “Yes,” provide details about the offense, including conviction date, court, and penalty. Also
attach a certified copy of the Criminal Docket Sheet and the Presentence Investigation Report.
3.
Have you ever been charged with any irregularities or shortages in your business accounts or
Yes
No
transactions?
If “Yes,” provide complete details of event(s).
4.
Have you ever been adjudicated as bankrupt?
Yes
No
If “Yes,” provide complete details of the event(s).
5.
Were you ever an owner, partner, director, officer, member or manager of any firm or company
Yes
No
which was adjudicated bankrupt or for which a receiver was appointed either during the time or
within one (1) year after you were connected with it?
If “Yes,” provide complete details of the event(s).
6.
Have you ever surrendered, resigned, cancelled, or been denied a professional license or other
Yes
No
credential in any jurisdiction?
Credit Counselor Initial Application
MUST BE RENEWED BY DECEMBER 1
ST
EACH YEAR
Revised 11/2021
Page 2 of 3
If “Yes,” provide details, including the name of the profession, the agency, and the agency
address.
7.
Has any licensing or other credentialing agency ever taken any disciplinary action against you,
Yes
No
including, but not limited to, any warning, reprimand, suspension, probation, limitation, or
revocation?
If “Yes,” provide details, including the name of the agency and the date of the action.
8.
Is disciplinary action pending against you in any jurisdiction?
Yes
No
If “Yes,” provide details, including the name of the agency and status of the action.
9.
Do you currently hold, or have you ever held, any license issued by the State of South Carolina?
Yes
No
(Not including a driver’s license)
If “Yes,” provide a copy.
10.
Have you read and are you familiar with State and Federal Credit Laws, such as the Fair Credit
Yes
No
Reporting Act, 15 U.S.C. §1681 et seq., Fair Debt Collection Practices Act, 15 U.S.C. § 1692 et
seq., and Bankruptcy Abuse Prevention and Consumer Protection Act of 2005, U.S. Public Law
109-8? *
11.
Have you read and are you familiar with the Consumer Credit Counseling Act, S.C. Code Ann.
Yes
No
§ 37-7-101 et seq.? *
*Required for all Counselors
VERIFICATION OF LAWFUL PRESENCE IN THE UNITED STATES
For instructions and more information, go to www.consumer.sc.gov. Please check only one box:
I am a United States citizen; or
I am a Legal Permanent Resident of the United States eighteen years of age or older; or
I am a Qualified Alien or non-immigrant under the Federal Immigration and Nationality Act, Public Law 82-
414, eighteen years of age or older, and lawfully present in the United States; or
Other: __________________________
Alien Number: ___________________
OTHER ATTACHMENTS: Please use the checklist below to verify your application is complete. Incomplete
information could result in delay or denial of your application.
$40 Application Fee
Request a Criminal History Check from the State Police in your place of residence. The report must be
sent directly to the Department, unless otherwise prohibited by law.
The undersigned warrants that his or her signature is duly authorized and delivered by and for the business for which s/he
signs. The undersigned swears or affirms and certifies that all information contained in this form and any attachments to
this form is true, accurate, and complete.
Signature
Title
Print Name
Date
NOTICE: SCDCA asks for personal information only when needed to fulfill a legitimate public purpose. SCDCA is required
to collect certain personal information during the application process. The type of information collected depends on state and
federal laws. SCDCA shares personal information when required or allowed by the South Carolina Freedom of Information
Act, the South Carolina Family Privacy Protection Act, and other applicable state and federal laws. For example, under state
law, we must share licensee data (including social security numbers) for all new and renewal licenses with the Child Support
Enforcement Division of the State Department of Social Services.
Credit Counselor Initial Application
MUST BE RENEWED BY DECEMBER 1
ST
EACH YEAR
Revised 11/2021
Page 3 of 3
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