Form CSC-014 "Representative Registration Application" - Texas

Form CSC-014 or the "Representative Registration Application" is a form issued by the Texas Workforce Commission.

The form was last revised in January 1, 2018 and is available for digital filing. Download an up-to-date Form CSC-014 in PDF-format down below or look it up on the Texas Workforce Commission Forms website.

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Download Form CSC-014 "Representative Registration Application" - Texas

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Texas Workforce Commission
Career Schools and Colleges
Representative Registration Application
Instructions: Please mail this completed form—with CSC-186 Fee Sheet and $90 fee to:
Texas Workforce Commission
Career Schools and Colleges—Controller
101 East 15th Street
Austin, Texas 78778-0001
School Information
School Number: S
School Name:
School’s Physical Address:
City:
State:
ZIP Code:
Applicant
First Name:
Last Name:
Social Security Number:
Date of Birth (mm/dd/yyyy):
Applicant’s Home Address:
Personal Phone Number:
Previous Names Used:
Required Statements
Instructions: By initialing each statement below, I certify that the statements are true and correct.
Initial
1. I do hereby agree, consent, and direct that any person or entity maintaining information in any
form relating to my criminal history shall release all such information upon the request of the
Texas Workforce Commission.
2. I do further hereby agree and permit the Texas Workforce Commission to obtain from any person
or entity information relating to my personal background, reputation, and character, and do hereby
expressly direct that any such person or entity release such information upon the request of the
Texas Workforce Commission.
3. I do hereby understand that I will not advise students about financial aid or administer the entrance
test.
4. I affirm that I will take the course Representative Training for Career Schools and Colleges before
I recruit or enroll students.
5. I do hereby release, discharge, and exonerate the Texas Workforce Commission, its agents or
representatives, and any person or entity so furnishing information from any and all liability of every
kind arising therefrom. The foregoing consent and release is valid and binding so long as I hold or seek
any certificate, license, or permit under the authority of Chapter 132 of the Texas Education Code. I
understand that purposely submitting false or misleading information on this application may subject
me to a fine, a prison sentence, or both. I understand that the cancellation policy [Section
132.061(a)(2)] provides for a full refund of all moneys paid by the student if it is established that the
enrollment of the student was procured as the result of any misrepresentation in advertising,
promotional materials of the school, or representations by the owner or representative of the school.
Page 1 of 2
CSC-014
Rev 01/18
I f
i
Texas Workforce Commission
Career Schools and Colleges
Representative Registration Application
Instructions: Please mail this completed form—with CSC-186 Fee Sheet and $90 fee to:
Texas Workforce Commission
Career Schools and Colleges—Controller
101 East 15th Street
Austin, Texas 78778-0001
School Information
School Number: S
School Name:
School’s Physical Address:
City:
State:
ZIP Code:
Applicant
First Name:
Last Name:
Social Security Number:
Date of Birth (mm/dd/yyyy):
Applicant’s Home Address:
Personal Phone Number:
Previous Names Used:
Required Statements
Instructions: By initialing each statement below, I certify that the statements are true and correct.
Initial
1. I do hereby agree, consent, and direct that any person or entity maintaining information in any
form relating to my criminal history shall release all such information upon the request of the
Texas Workforce Commission.
2. I do further hereby agree and permit the Texas Workforce Commission to obtain from any person
or entity information relating to my personal background, reputation, and character, and do hereby
expressly direct that any such person or entity release such information upon the request of the
Texas Workforce Commission.
3. I do hereby understand that I will not advise students about financial aid or administer the entrance
test.
4. I affirm that I will take the course Representative Training for Career Schools and Colleges before
I recruit or enroll students.
5. I do hereby release, discharge, and exonerate the Texas Workforce Commission, its agents or
representatives, and any person or entity so furnishing information from any and all liability of every
kind arising therefrom. The foregoing consent and release is valid and binding so long as I hold or seek
any certificate, license, or permit under the authority of Chapter 132 of the Texas Education Code. I
understand that purposely submitting false or misleading information on this application may subject
me to a fine, a prison sentence, or both. I understand that the cancellation policy [Section
132.061(a)(2)] provides for a full refund of all moneys paid by the student if it is established that the
enrollment of the student was procured as the result of any misrepresentation in advertising,
promotional materials of the school, or representations by the owner or representative of the school.
Page 1 of 2
CSC-014
Rev 01/18
Professional Conduct
Instructions: If you answer Yes to A, B, C, or D below, complete form CSC-014B
Professional Conduct. Sign the form and obtain the signature of a school official
Check Yes or No,
certifying the truth and accuracy of all statements made to explain the circumstances.
below
Attach CSC-014B to this application and submit it with the other required documents.
A. Have you ever had a diploma, credential, license, or certificate denied, revoked, or
☐ Yes
☐ No
suspended?
B. Have you ever been dismissed or asked to resign from any position for immoral or
☐ Yes
☐ No
unprofessional conduct?
☐ Yes
☐ No
C. Have you ever been sued successfully for fraud or deceptive trade practices?
D. Have you ever been convicted of a felony or of a misdemeanor other than minor
☐ Yes
☐ No
traffic offenses?
Applicant’s Certification
I certify that I have read and agree to fully comply with the provisions of Chapter 132, Texas Education
Code and Chapter 807, Texas Administrative Code, Career Schools and Colleges, which was given to me
by the school that I will be representing.
Typed or Printed Name of Applicant:
Signature of Applicant:
Date:
Certification
I certify that the above-named applicant has been given instructions concerning compliance with Texas
Education Code, Chapter 132, Career Schools and Colleges, and Texas Administrative Code, Chapter 807,
Career Schools and Colleges, and is a duly qualified agent of this school.
Typed or Printed Name of Owner, Director, or Owner Designee:
Title:
Signature of Owner, Director, or Owner Designee:
Date:
Notary
State of
County of
, where witnessed.
Subscribed and sworn to me this (mm/dd/yyyy)
My commission expires: (mm/dd/yyyy)
Signature of Notary:
STAMP/SEAL
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CSC-014
Rev 01/18
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