Form EA-649-002 "Employment Agency, Branch Office, or Listing/Directory Service License Application" - Washington

What Is Form EA-649-002?

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

Form Details:

  • Released on August 1, 2016;
  • The latest edition provided by the Washington State Department of Licensing;
  • 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 fillable version of Form EA-649-002 by clicking the link below or browse more documents and templates provided by the Washington State Department of Licensing.

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Download Form EA-649-002 "Employment Agency, Branch Office, or Listing/Directory Service License Application" - Washington

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Click here to START or CLEAR, then hit the TAB button
Employment Agency, Branch Office, or
Listing/Directory Service License Application
Use this form to apply for an Employment Agency, Branch Office, or
For validation only
Listing/Directory Service license. Send this form and required documents,
with a check or money order payable to Department of Licensing to:
Business and Professions
Department of Licensing
001-070-231-0003
PO Box 35001
Seattle WA 98124-3401
Application type
(choose one):
Employment Agency – $783
Branch Office – $540
Listing/Directory Service – No fee
All license types must include the following documents with this application:
$2,000 bond (use Employment Agency Surety Bond form available at dol.wa.gov/forms/649001.pdf)
Copy of the client contract
Copy of the client fee schedule
Employment Agency, Branch Office, or Listing Service must also include:
Employment Agency General Manager Examination Application and fee (if the general manager is not currently
licensed in Washington)
Business information
Business entity name
UBI number
Address
City
State
Zip code
Mailing address (if different)
City
State
Zip code
(Area code) phone number
Email address
General manager
(employment agency, branch office, or listing service only)
PRINT or TYPE Name (Last, First, Middle)
General manager license number*
Mailing address
City
State
Zip code
(Area code) phone number (during normal business hours)
Email address
*If not licensed in Washington, the general manager must complete an Employment Agency General Manager Examination Application
(dol.wa.gov/forms/649006.pdf) and include all applicable fees.
(continued on next page)
EA-649-002 (N/8/16)WA Page 1 of 2
Click here to START or CLEAR, then hit the TAB button
Employment Agency, Branch Office, or
Listing/Directory Service License Application
Use this form to apply for an Employment Agency, Branch Office, or
For validation only
Listing/Directory Service license. Send this form and required documents,
with a check or money order payable to Department of Licensing to:
Business and Professions
Department of Licensing
001-070-231-0003
PO Box 35001
Seattle WA 98124-3401
Application type
(choose one):
Employment Agency – $783
Branch Office – $540
Listing/Directory Service – No fee
All license types must include the following documents with this application:
$2,000 bond (use Employment Agency Surety Bond form available at dol.wa.gov/forms/649001.pdf)
Copy of the client contract
Copy of the client fee schedule
Employment Agency, Branch Office, or Listing Service must also include:
Employment Agency General Manager Examination Application and fee (if the general manager is not currently
licensed in Washington)
Business information
Business entity name
UBI number
Address
City
State
Zip code
Mailing address (if different)
City
State
Zip code
(Area code) phone number
Email address
General manager
(employment agency, branch office, or listing service only)
PRINT or TYPE Name (Last, First, Middle)
General manager license number*
Mailing address
City
State
Zip code
(Area code) phone number (during normal business hours)
Email address
*If not licensed in Washington, the general manager must complete an Employment Agency General Manager Examination Application
(dol.wa.gov/forms/649006.pdf) and include all applicable fees.
(continued on next page)
EA-649-002 (N/8/16)WA Page 1 of 2
Criminal history
Answer the following (owner, officer, or partner)
In this state or any other jurisdiction, have (are) any business owners, any persons with controlling interest in this
business, or the business entity:
1. Within the last 10 years, had any action (fine, suspension, revocation, censure, surrender, etc.)
taken against any professional or occupational license, certification, or permit held by you? . . . . . . .
Yes
No
2. Within the last 10 years, had any civil court order, verdict, or judgment entered against you? . . . . . . .
Yes
No
3. Within the last 10 years, defaulted or been convicted of or entered a plea of no contest to a
gross misdemeanor or felony crime? (Don’t include traffic offenses.) . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
4. Currently under indictment, or is there a criminal complaint, charge, or information
pending against you? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
5. Been engaged in, interested in, or employed by anyone engaged in the business of
an employment agency? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If you answered “yes” to any of questions 1 through 4, explain on a separate sheet. Include the name of the person
involved; charge(s), date of conviction, civil judgement or order; county and state; and disposition of charges.
Ownership
List of persons with 20% or more ownership in the company.
Name
Address
% owned
Name
Address
% owned
Name
Address
% owned
Name
Address
% owned
Name
Address
% owned
Corporate officers
(corporations only)
Name
Address
Name
Address
Name
Address
Name
Address
Name
Address
This form must be signed by the owner, a corporate officer or partner of the business.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
Print name
Title
X
When you have completed this form, please print it out and sign here.
Date and place
Signature
EA-649-002 (N/8/16)WA Page 2 of 2
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