ࡱ> q` 6XbjbjqPqP 4~::o xRd ***8*TJ+,P=, /(H/H/H/#0r2,3<<<<<<<$>hn@r<]=5#0#0=5=5<H/H/ =S8S8S8=5H/H/<S8=5<S8S8S8H/v, vWJ*Y5S88 =0P=S8@i5@S8@S88Y4"{4S844Y4Y4Y4<<C8Y4Y4Y4P==5=5=5=5D))4,"N Application for Permit To Engage in Street Sales or Solicitation (Code of Virginia, Section 40.1-112) Date of Application FORMTEXT  DATE 6/25/20086/25/2008 A separate permit must be obtained for each location with a permanent address, and for each metropolitan area, city or town in which a traveling crew is working. Some local municipalities may require additional permits. Please check with each local government. Name of agency:  FORMTEXT       Address of home office:  FORMTEXT       Telephone #  FORMTEXT       Address of branch office:  FORMTEXT       Telephone #  FORMTEXT       Name of person making application:  FORMTEXT        (Signature)(Title) Relationship with home agency:  FORMTEXT      (Employee, Independent Contractor, Officer) How long has agency been in operation in this state?  FORMTEXT       If new, what is the opening date?  FORMTEXT       Is this a traveling crew?  FORMTEXT       Specify all cities, counties, and metropolitan areas to be covered:  FORMTEXT      (Note: Cities counties and municipalities in Virginia may require additional permits to engage in sales) Address at which required records will be available for inspection:  FORMTEXT       Address from which geographical crew will be operating:   FORMTEXT      (Hotel, Motel, etc.)  Telephone #  FORMTEXT       Arrival and departure dates at this address: Arrival:  FORMTEXT       Departure:  FORMTEXT       Number of employees per this geographical area:  FORMTEXT       number under 18:   FORMTEXT      number under 16  FORMTEXT       Names and Dates of Birth for all employees: Afg{|) D F Z \ ^ h j ̷̷̥؝ؑ؂pؑapؑjhOJQJU"jhOJQJUmHnHujvhOJQJUjhOJQJUhcaSOJQJ#jhXhXOJQJUhaOJQJmHnHuhXOJQJjhXOJQJUhOJQJh>*OJQJhCJOJQJhOJQJ\h%Afg{ $$Ifa$Ekdz$$Ifl0 n3  4 la; $$Ifa$$a$ $ H@&a$$a$ DW4X  dh$If^kd$$Ifl0**04 la   B D l dh$Iftkd$$Ifl400*(t"04 laf4l n p r dh$Iftkd0$$Ifl40 0* 04 laf4      6 8 L N P Z \ N P d f h r t B D X ʻʬʝʕzh"jhaOJQJUmHnHuj haOJQJUjhaOJQJUhaOJQJjhOJQJUjlhOJQJUj:hOJQJUhOJQJ"jhOJQJUmHnHujhOJQJUjhOJQJU$  wnnnn dh$Ifkdp$$Ifl4F 0*0    4 laf4    4 6 ^ dh$Iftkd$$Ifl40@ 0* 04 laf4^ ` b wnnnn dh$Ifkd$$Ifl4F 0*0    4 laf4 ||s|| dh$If $dh$Ifa$vkd8$$Ifl4L0x0*04 laf4 ui]i dh$Ifgda $dh$Ifa$kd$$Ifl4FHV0*0    4 laf4  N v ull` $dh$Ifa$ dh$Ifkd $$Ifl4FHV0*0    4 laf4v x z s $dh$Ifa$ dh$Ifvkd2 $$Ifl4M00*| 04 laf4 @ B j  dh$Ifvkd $$Ifl4(00*| 04 laf4X Z \ f h ,.0:<@D\ʻʬʣn_S_haCJOJQJaJhahaCJOJQJaJ"jhOJQJUmHnHujhOJQJUjhOJQJUhOJQJh>*OJQJj0haOJQJUj haOJQJUhaOJQJ"jhaOJQJUmHnHujhaOJQJUj haOJQJU j l n dh$Iftkd* $$Ifl400*TH04 laf4 > dh$Iftkdn$$Ifl40x0*04 laf4>@BDF~vmm dh$If$dha$ $@ dh`@ a$tkd$$Ifl40 0* 04 laf48^kdn$$Ifl4X0**04 laf4 dh$If^kd`$$Ifl4X0**04 laf4XZ\^kd$$Ifl40**04 laf4 dh$If dh$Ifgda\^rtv "tv&(*46PRfhjtvsjhOJQJUaJhhOJQJaJhjBhOJQJUjhOJQJUj|hOJQJUjhOJQJU"jhOJQJUmHnHujhOJQJUhOJQJjhOJQJU&$ dh$If^kd$$Ifl40**04 laf4$&(Rx $dh$Ifa$ dh$Ifqkd$$Ifl400*TH04 laf4RTVXZrt dh$Ifqkd$$Ifl40&0* 04 laf4x|ssss dh$Ifkd$$Ifl4F 0*0    4 laf4xz|ww !dh$1$If dh$Ifokd$$Ifl400*h404 laf402FHJTV|~PPP\PfPPPPPݽyqodYNdha5OJQJ\hcaS5OJQJ\h5OJQJ\UhcaSOJQJj$hOJQJU"jhOJQJUmHnHujhOJQJUjhOJQJUhOJQJhOJQJaJh)jhOJQJUaJhmHnHujhOJQJUaJh$jhOJQJUaJh .0XZz|zznz $dh$Ifa$ $dh$Ifa$ dh$Ifokd$$Ifl400*04 laf4 PP\PPVMMDD $$Ifa$ $dh@&a$kd$$Ifl4rpHV 0* 04 laf4(Attach additional sheet if necessary.) NamesBirth Date mm/yyyy FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       Proposed hours of work for employees:  FORMTEXT       Rate of compensation for employees:  FORMTEXT       Name of crew manager:  FORMTEXT       Items to be sold or solicited:  FORMTEXT      This department shall be advised of any changes in your operation after the issuance of this permit. Failure to do so will result in revocation of your permit.  PERMITS NOT TRANSFERABLE Return Application to: Virginia Department of Labor and Industry Labor Law Division Powers-Taylor Building 13 South Thirteenth Street Richmond, Virginia 23219 Phone: (804) 786-2386 Fax: (804) 371-2324     Application for Permit to Engage in Street Sales or Solicitation Page  PAGE 1 of  NUMPAGES 3 PPPP $dh$Ifa$nkd$$Ifl00*NN04 laPPPPPPPPPPPPPPPPPPPPPQQQQ"Q$Q(Q*Q>Q@QBQLQNQPQRQfQhQjQtQvQzQ|QQQqj&!hOJQJUj hOJQJUjhOJQJUjhOJQJUj"hOJQJUjhOJQJU"jhOJQJUmHnHujhOJQJUjhOJQJUhOJQJ,PPP&Q $dh$Ifa$qkdx$$Ifl400*NN04 laf4&Q(QPQxQ $dh$Ifa$qkd$$Ifl400*NN04 laf4xQzQQQ $dh$Ifa$qkd $$Ifl400*NN04 laf4QQQQQQQQQQQQQQQQQQQQ R RRRRR R4R6R8RBRDRFRHR\R^R`RjRlR|RRRRRRRٻ٬َٝكtj%hOJQJUhOJQJaJhj$hOJQJUj*$hOJQJUj#hOJQJUj"hOJQJUj!hOJQJUhOJQJ"jhOJQJUmHnHujhOJQJU-QQQR $dh$Ifa$qkd "$$Ifl400*NN04 laf4RRFRnR $dh$Ifa$qkd#$$Ifl400*NN04 laf4nRpRrRvR|RRRRyypp $$Ifa$  !$1$If$dha$qkd%$$Ifl400*NN04 laf4RRR@SBSVSXSZSdSfSSSSSSSSTTTT T*T,TvUxUUUUUXVZVVڼڭڤ{ndWhOJQJ^JaJhhOJQJ^Jh5OJQJ\^Jhh6>*CJOJQJ]^Jh>*CJOJQJhCJOJQJh>*OJQJjZ)hOJQJUj(hOJQJUj&hOJQJUhOJQJjhOJQJU"jhOJQJUmHnHu RRR>S@ShS $$Ifa$$Ifnkd"&$$Ifl00*LP04 lahSjSlSSSS$Ifnkd^'$$Ifl0,0*04 laSSSTT.T $$Ifa$$Ifnkd($$Ifl0@ 0* 04 la.T0TtUvU(^kd*$$Ifl40**04 laf4 $$Ifa$nkd)$$Ifl0 0* 04 lavUxUzUUUUUU4VZVVVVWDWHWJWNWPWTWVWZW\W@& ^`  !1$@&$`a$$`a$dh` $@ dh`@ a$VVVWBWDWFWJWLWPWRWVWXW\WWWWWWXXX XXX(X*X,X.X˽rWrrW4ha0J56CJOJQJ\]aJhmHnHu)h0J56CJOJQJ\]aJh2jh0J56CJOJQJU\]aJhh56CJ\]h56CJOJQJ\]h56CJOJQJ]hajhaUhhOJQJ^JhOJQJ^JaJhh5CJOJQJ^J\W0X2X4X6X@&.X0X2X4X6Xhahh6CJOJQJ]2 00P/ =!"#$% zDapp_datep$$If; !vh5 5 #v #v :V l5 5 / 4a; $$If!vh5*#v*:V l05*/ 4D agency_name$$If!vh5(5t"#v(#vt":V l40,5(5t"/ /  4f4D home_office$$If!vh5 5#v #v:V l405 5/ / /  4f4~D home_offph$$If!vh555#v#v#v:V l40555/ /  4f4~D branch_off$$If!vh5 5#v #v:V l405 5/ /  4f4|D branch_ph$$If!vh555#v#v#v:V l40555/ /  4f4Dapplicant_name$$If!vh55#v#v:V l4L055/ /  4f4$$If!vh555#v#v#v:V l40+,555/  / /  / 4f4$$If!vh555#v#v#v:V l40+,555/ 4f4D relationship$$If!vh5|5 #v|#v :V l4M0,5|5 / /  4f4$$If!vh5|5 #v|#v :V l4(0,5|5 / / 4f4|D yrs_in_op$$If!vh5T5H#vT#vH:V l405T5H/ /  / 4f4D opening_date$$If!vh55#v#v:V l4055/ /  / 4f4|D trav_crew$$If!vh5 5#v #v:V l405 5/ /  4f4$$If!vh5*#v*:V l4X05*/ 4f4zDcty_cnty$$If!vh5*#v*:V l4X05*/  4f4$$If!vh5*#v*:V l405*/ 4f4xDadd_rec$$If!vh5*#v*:V l405*/  4f4xDadd_geo$$If!vh5T5H#vT#vH:V l405T5H/ /  4f4$$If!vh55 #v#v :V l4055 / 4f4vDgeo_ph$$If!vh555#v#v#v:V l40555/ /  / 4f4xDarrival|D departure$$If!vh5h54#vh#v4:V l405h54/ /  / 4f4vDno_emp$$If!vh55#v#v:V l4055/ /  4f4zDunder_18zDunder_162$$If!vh55 555#v#v #v#v#v:V l40,55 555/ / / / / /  4f4$$If!vh5N5N#vN:V l05N/ / / / 4tDname1rDssn1$$If!vh5N5N#vN:V l405N/ / 4f4tDname2rDssn2$$If!vh5N5N#vN:V l405N/ 4f4tDname3rDssn3$$If!vh5N5N#vN:V l405N/ 4f4tDname4rDssn4$$If!vh5N5N#vN:V l405N/ 4f4tDname5rDssn5$$If!vh5N5N#vN:V l405N/ 4f4tDname6rDssn6$$If!vh5N5N#vN:V l405N/ 4f4vDhrs_wk$$If!vh5L5P#vL#vP:V l05L5P/ /  / 4|D rate_comp$$If!vh55#v#v:V l055/ /  / 4|D crew_mngr$$If!vh5 5#v #v:V l05 5/ /  / 4~D items_sold$$If!vh5 5#v #v:V l05 5/ /  / 4$$If!vh5*#v*:V l40,5*/ 4f4@@@ NormalCJ_HaJmH sH tH P@P Heading 1$@&^` 5CJaJT@T Heading 2$$@ 1$@&`@ a$>*CJaJhJ@J Heading 3$ H1$@& 5aJhV@V Heading 4$p1$@&^p`5CJaJhDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List > @> Footer !1$aJh>@> Header !1$aJhF>@F Title$ H@&a$5OJQJ\.)@!. 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