Form SF045 "Pyrotechnic, Special Effects and Flame Effects Operator's License Application" - Texas

What Is Form SF045?

This is a legal form that was released by the Texas Department of Insurance - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Texas Department of Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form SF045 by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.

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Download Form SF045 "Pyrotechnic, Special Effects and Flame Effects Operator's License Application" - Texas

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SF045 | 06/18
PYROTECHNIC, SPECIAL EFFECTS AND FLAME EFFECTS OPERATOR’S LICENSE APPLICATION
This application must be accompanied by all documents and information required by Chapter 2154 of the Texas Occupations Code
and the Fireworks Rules, AND THE ORIGINAL SCORE REPORT RECEIVED FROM THE TEST ADMINISTRATOR SHOWING A PASSING
SCORE FOR THE REQUIRED TESTS. Please note that test scores are valid for one year from the date the test was taken.
Complete answers must be given to all items. Please print or type. An operator's license shall not be issued to any person who is
under 21 years of age. Any fraudulent representation on this application may be cause for denial, suspension, or revocation of a
license.
All fees are non-refundable, except for overpayments resulting from mistakes of law or fact.
LICENSE
DO NOT SUBMIT THIS APPLICATION UNTIL
CHECK ONE
TYPE OF LICENSE
LICENSE FEE
CODE
ALL TEST REQUIREMENTS HAVE BEEN MET
Pyrotechnic Operator
$45
570-05
Pyrotechnic Special Effects Operator
$45
570-11
Flame Effects Operator
$45
128
APPLICANT
LAST NAME
FIRST NAME AND MIDDLE NAME
HOME AREA CODE AND TELEPHONE
HOME ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
CITY
STATE
ZIP CODE
COUNTY OF RESIDENCE
E-MAIL ADDRESS FOR NOTIFICATION PURPOSES (optional)
SOCIAL SECURITY NUMBER
DRIVER'S LICENSE NUMBER AND STATE
(Disclosure of Social Security Number is required by the Texas Family
Code §231.302 and will be used pursuant to that code.)
WEIGHT
HEIGHT
SEX
COLOR OF HAIR
COLOR OF EYES
DATE OF BIRTH
APPLICANT'S EMPLOYER
NAME OF FIRM
AREA CODE AND TELEPHONE
ADDRESS OF FIRM
CITY
STATE
ZIP CODE
Federal Bureau of Investigation (FBI) BACKGROUND PROCESS
An FBI Background is required through IdentoGO and requires a unique service code that will be needed when scheduling for submission for your
Electronic fingerprints.
Email
jakeryan.woolf@tdi.texas.gov
with the following information in order to obtain the service code and procedures:
First Name, Last Name, current mailing address and the type of license you will be applying for.
QUESTIONS
1
Do you hold a current license issued by the Texas State Fire Marshal?
YES
NO
If yes, print license number(s) here.
2
Have you ever held a license issued by the Texas State Fire Marshal that is not shown in questions 1 above?
YES
NO
Texas Department of Insurance | www.tdi.texas.gov
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SF045 | 06/18
PYROTECHNIC, SPECIAL EFFECTS AND FLAME EFFECTS OPERATOR’S LICENSE APPLICATION
This application must be accompanied by all documents and information required by Chapter 2154 of the Texas Occupations Code
and the Fireworks Rules, AND THE ORIGINAL SCORE REPORT RECEIVED FROM THE TEST ADMINISTRATOR SHOWING A PASSING
SCORE FOR THE REQUIRED TESTS. Please note that test scores are valid for one year from the date the test was taken.
Complete answers must be given to all items. Please print or type. An operator's license shall not be issued to any person who is
under 21 years of age. Any fraudulent representation on this application may be cause for denial, suspension, or revocation of a
license.
All fees are non-refundable, except for overpayments resulting from mistakes of law or fact.
LICENSE
DO NOT SUBMIT THIS APPLICATION UNTIL
CHECK ONE
TYPE OF LICENSE
LICENSE FEE
CODE
ALL TEST REQUIREMENTS HAVE BEEN MET
Pyrotechnic Operator
$45
570-05
Pyrotechnic Special Effects Operator
$45
570-11
Flame Effects Operator
$45
128
APPLICANT
LAST NAME
FIRST NAME AND MIDDLE NAME
HOME AREA CODE AND TELEPHONE
HOME ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
CITY
STATE
ZIP CODE
COUNTY OF RESIDENCE
E-MAIL ADDRESS FOR NOTIFICATION PURPOSES (optional)
SOCIAL SECURITY NUMBER
DRIVER'S LICENSE NUMBER AND STATE
(Disclosure of Social Security Number is required by the Texas Family
Code §231.302 and will be used pursuant to that code.)
WEIGHT
HEIGHT
SEX
COLOR OF HAIR
COLOR OF EYES
DATE OF BIRTH
APPLICANT'S EMPLOYER
NAME OF FIRM
AREA CODE AND TELEPHONE
ADDRESS OF FIRM
CITY
STATE
ZIP CODE
Federal Bureau of Investigation (FBI) BACKGROUND PROCESS
An FBI Background is required through IdentoGO and requires a unique service code that will be needed when scheduling for submission for your
Electronic fingerprints.
Email
jakeryan.woolf@tdi.texas.gov
with the following information in order to obtain the service code and procedures:
First Name, Last Name, current mailing address and the type of license you will be applying for.
QUESTIONS
1
Do you hold a current license issued by the Texas State Fire Marshal?
YES
NO
If yes, print license number(s) here.
2
Have you ever held a license issued by the Texas State Fire Marshal that is not shown in questions 1 above?
YES
NO
Texas Department of Insurance | www.tdi.texas.gov
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SF045 | 06/18
QUESTIONS (cont)
3
Have you ever had a permit or license denied, suspended, or revoked?
YES
NO
If yes, give details on a separate sheet and attach it to this application.
4
Have you ever been convicted of a misdemeanor or a felony (including any deferred adjudication)?
YES
NO
If yes, give details on a separate sheet and attach it to this application.
5
Do you store fireworks in the state of Texas?
YES
NO
If yes, please complete the section below.
LOCATIONS IN TEXAS WHERE YOU STORE FIREWORKS
(List all locations where fireworks 1.3G & 1.4G are stored)
INDICATE CLASSIFICATION
LOCATION
ESTIMATED MAX. WEIGHT
(If no street address, please describe exact location)
CODE 1.4G OR 1.3G
DURING THE YEAR
Street Address
City, State
Gross Weight
* Net Weight
* Net weight is the weight of all pyrotechnic and explosive compositions and fuse only.
PUBLIC FIREWORKS DISPLAY EXPERIENCE
(to be completed by pyrotechnic operator applicants – not special effects or flame effects)
List five permitted or licensed public displays using Fireworks 1.3G that you assisted in conducting in the State of Texas under the direct supervision
of a pyrotechnic operator licensed in Texas. Verification from the pyrotechnic operator is required as evidenced by their signature below or some
other form of written confirmation.
CITY
DATE
PYROTECHNIC OPERATOR'S NAME OR SIGNATURE
PYROTECHNIC OPERATOR'S LICENSE NO.
CITY
DATE
PYROTECHNIC OPERATOR'S NAME OR SIGNATURE
PYROTECHNIC OPERATOR'S LICENSE NO.
CITY
DATE
PYROTECHNIC OPERATOR'S NAME OR SIGNATURE
PYROTECHNIC OPERATOR'S LICENSE NO.
CITY
DATE
PYROTECHNIC OPERATOR'S NAME OR SIGNATURE
PYROTECHNIC OPERATOR'S LICENSE NO.
CITY
DATE
PYROTECHNIC OPERATOR'S NAME OR SIGNATURE
PYROTECHNIC OPERATOR'S LICENSE NO.
SIGNATURES
In applying for a pyrotechnic operator's license, a special effects operator’s license, or a flame effects operator’s license, I certify that I will comply
with Chapter 2154 of the Texas Occupations Code, and the Fireworks Rules.
I know of no reason why I should be denied a license.
By my signature, I verify that the information, included or provided on this application and any attachment, is complete and true.
I understand that knowingly providing a false answer to any question or submitting false information or documents with this application may be
tampering with a governmental record which is punishable under the Texas Penal Code Chapter 37, §37.10.
SIGNATURE OF INDIVIDUAL APPLICANT
DATE
Check or money order should be made payable to the TEXAS DEPARTMENT OF INSURANCE.
Mail this completed application along with the appropriate fee and any additional documents to:
Mailing Address:
State Fire Marshal's Office
Telephone No.
(512) 676-6810
P. O. Box 149221
Fax No.
(512) 490-1056
Austin, Texas 78714-9221
Web Site Address:
www.tdi.texas.gov/fire
NOTICE ABOUT CERTAIN INFORMATION LAWS AND PRACTICES
With few exceptions, you are entitled to be informed about the information that the Texas Department of Insurance (TDI) collects about you. Under sections 552.021
and 552.023 of the Texas Government Code, you have a right to review or receive copies of information about yourself, including private information. However, TDI
may withhold information for reasons other than to protect your right to privacy. Under section 559.004 of the Texas Government Code, you are entitled to request
that TDI correct information that TDI has about you that is incorrect. For more information about the procedure and costs for obtaining information from TDI or about
the procedure for correcting information kept by TDI, please contact the Agency Counsel Section of TDI’s General Counsel Division at (512) 676-6551 or visit the
Corrections Procedure section of TDI’s website at www.tdi.texas.gov.
Texas Department of Insurance | www.tdi.texas.gov
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