Cosmetology Background Affidavit

Cosmetology Background Affidavit
If you have been convicted of a felony, it is important that you understand that although the Kentucky State Board of Cosmetology will certify the hours you receive in Kentucky, but at the Boards discretion, there is a possibility that you may not become licensed in the state. By signing this document you understand that while you may enroll into Cosmetology at the College for Technical Education, you may be denied licensure if you have been convicted of a felony offences. You understand statute 317A 140; Grounds for refusal to issue, renew, revoke, or suspend license, states that conviction of a felony offense may prevent you from gaining licensure with the Kentucky State Board of Cosmetology.
I,Your Name* , am applying for admissions into the College of Technical Education for the Cosmetology, Esthetics or Nail Technology program.
My past criminal history includes the following convictions and approximate dates (if none, write none):*
I attest that the above represents a complete history of my past criminal convictions. I further understand that my past criminal history may make it difficult to acquire placement in the field of Cosmetology.*

MonthDayYear
Signed Date
Your Legal Name*
Your Email Address*
example@example.com
I agree by signing and submitting this form to be legally bound by this agreement.
Signature*

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