Fillable (1002) COSMETOLOGIST APPLICATION FOR EXAMINATION AND INITIAL LICENSE (California)

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(1002) COSMETOLOGIST APPLICATION FOR EXAMINATION AND INITIAL LICENSE (California)

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Form #F-34555-BOC (Revised November 2020) Page 1 of 7
(1002) COSMETOLOGIST APPLICATION FOR EXAMINATION
AND INITIAL LICENSE FEE* $125.00 (non-refundable)
*If you are applying as a spouse or registered domestic partner of an active military member
(Section E(5)) or have served as an active duty member and have been honorably discharged from
the United States Armed Forces (Section E(6), please check this box.
Cashiering
Use Only:
1015
Entity #
Receipt #
Amount
$
I qualify for the examination as a (See Section D) (choose one):
California Student California Apprentice Out of State Out of Country Previously Licensed
SECTION A: APPLICANT INFORMATION
Attach a copy of your government-issued
photographic identification. NOTE: The name on the identification and the name entered on this
application must match to gain admission to the examination.
Social Security Number or Individual Taxpayer
Identification Number
- -
Date of Birth (must be at least 17 years old)
- -
Month Day Year
First Name
Middle Name
Note: Double check your address and notify the Board of Barbering and Cosmetology (Board)
immediately via email at barbercosmo@dca.ca.gov if your address changes. Government mail
is not forwarded.
Address (the address where your scheduling letter will be mailed)
Apartment # (if applicable)
City
State
Zip Code
Telephone Number
- -
E-mail Address
SECTION B: EXAM INFORMATION
Exam Location
North (Fairfield)
South (Glendale)
Exam Language Preference
English Vietnamese Spanish Korean
These examinations are translated into the most universal or
neutral version of each language to be acceptable to the
widest possible audience.
BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY ● GAVIN NEWSOM, GOVERNOR
.
DEPARTMENT OF CONSUMER AFFAIRS ● BOARD OF BARBERING AND COSMEOLOGY
P.O. Box 944226, Sacramento, CA 94244-2260
P (800) 952-5210 F (916) 575-7281 www.barbercosmo.ca.gov
Form #F-34555-BOC (Revised November 2020) Page 2 of 7
SECTION B: CONTINUED
Interpreter: If you do not speak and read one of
the language preferences above, attach a
completed Interpreter or Interpreter/ Model Forms G
& H with this application.
Reasonable Accommodation: If you require a
reasonable accommodation to take the exam,
attach a completed Request for Reasonable
Accommodation form with this application.
NOTE: Once the Board has scheduled you to take the practical portion of the exam, the practical
exam date cannot be changed. If you cannot take your practical exam on the scheduled date,
you must submit an Application for Re-Examination and pay the required fee. If there is an
upcoming date you cannot take the exam, the Board will schedule you after that date.
Please schedule me after this date: _________________________________
SECTION C: SCHOOL/GRADUATION INFORMATION (California Students Only)*
School Name
School Phone Number
Date you Started Training at this School
- -
Month Day Year
Date you Completed Training at this School
- -
Month Day Year
Total Hours
Completed
*Attach your Proof of Training Document(s) (except previously licensed – see section D) or for
apprentices your Certificate of Completion.
SECTION D: QUALIFICATIONS (choose one)
California Students
I completed the required hours from a California Board approved school(s) and attached the
Proof of Training Document(s).
I previously held a license in the State of California that was cancelled.
License Number: ______________ Name on previous license: __________________________
California Apprentices
I completed my California apprentice training and have attached a Certificate of Completion.
Military Training
I completed comparable military training and have attached my Verification of Military
Experience and Training records.
Out of State Applicants
I studied in another state and did not receive a license. I am submitting an Out-of-State Applicant
School Training Record – Form B and transcripts with this application to the Board.
I hold a current (or expired) license in another state. The current license has been active for less
than 3 years. I requested the other state to send a Certification of Licensure* directly to the
Board.
State Name License Type License #
* Washington state applicants are not required to submit a Certification of Licensure (attach a
copy of your license).
Out of Country Applicants
I attended school and/or held a license in another country.
Country ___________________ License Type_________________ License #_______________
The Board will be requesting additional information to verify the education you received meets
the Board’s requirements.
Reciprocity Applicants
If you hold a current license in another state and have held that license for at least 3 years, please see
Reciprocity information on page 6.
Form #F-34555-BOC (Revised November 2020) Page 3 of 7
SECTION E: BACKGROUND INFORMATION
1. Have you ever been convicted of or pled no contest to, a violation of any law of the United States, in
any state, local jurisdiction, or any foreign country? No Yes If yes, please complete the
Disclosure Statement Regarding Criminal Pleas/Convictions form with this application. If needed, the
Board will send you a letter requesting additional information.
2. Have you ever had any professional or vocational license or application denied, suspended, revoked,
placed on probation or other disciplinary action taken by this or any other governmental authority in this
state or any other state, or any foreign country? No Yes If yes, please complete the Disclosure
Statement Regarding Disciplinary Action form with this application. If needed, the Board will send you a
letter requesting additional information.
3. Do you hold any license(s) with the California Board? No Yes If yes, License
Number(s)____________________________. If the name on your other license(s) does not match the
name on this application, please submit a Notification of Name Change form with the required
documentation with this application.
4. Have you served, or are you currently serving, in the military? No Yes
5. Are you a spouse or registered domestic partner of an active military member and are requesting this
application be expedited? No Yes If yes, attach a copy of your certificate of marriage or domestic
partnership, and a copy of your spouse’s or registered domestic partner’s current military ID and
verification of their active duty status.
6. Have you served as an active military member and have been honorably discharged from the United
States Armed Forces and are requesting this application be expedited? No Yes
If yes, attach your discharge papers.
7. Have you completed the 10th grade in a public school or its equivalency? No Yes
If no, you cannot proceed.
8. (Optional) What is your spoken and written language preference? ____________________________
9. Business and Professions Code section 135.4 provides that the Board must expedite, and may assist,
the initial licensure process for certain applicants described below.
Do any of the following statements apply to you:
• You were admitted to the United States as a refugee pursuant to section 1157 of title 8 of the United
States Code;
• You were granted asylum by the Secretary of Homeland Security or the United States Attorney
General pursuant to section 1158 of title 8 of the United States Code; or,
• You have a special immigrant visa and were granted a status pursuant to section 1244 of Public Law
110-181, Public Law 109-163, or section 602(b) of title VI of division F of Public Law 111-8, relating
to Iraqi and Afghan translators/interpreters or those who worked for or on behalf of the United States
government.
No Yes If you selected YES, you must attach evidence of your status as a refugee, asylee, or
special immigrant visa holder. Failure to do so may result in application review delays.
Form #F-34555-BOC (Revised November 2020) Page 4 of 7
SECTION F: APPLICANT CERTIFICATION
I certify that I have read and understand the information, Know Your Workers’ Rights, provided by the
California Board of Barbering and Cosmetology. I certify that I have read and understand the laws and
regulations pertaining to this profession in California. I certify under penalty of perjury under the laws of
the State of California that all statements furnished in connection with this application are true and
accurate.
Signature
Date
Form #F-34555-BOC (Revised November 2020) Page 5 of 7
APPLICATION FOR EXAMINATION INSTRUCTIONS
QUALIFICATIONS
Qualifications to take the Board’s exams:
•
Be at least 17 years of age.
•
Has completed the 10th
grade in a public school or its equivalency (12th
grade for electrology
applicants).
•
Has committed no acts or crimes constituting grounds for denial of licensure under Section 480
of the Business and
Professions Code.
•
Has completed the following hours in a Board approved school or has completed a 3200 hour
apprentice program:
Cosmetologist
1600 Hours
Esthetician
600 Hours
Manicurist
400 Hours
Barber
1500 Hours
Electrologist
600 Hours
PROOF OF TRAINING DOCUMENT
First time applications for examination (excluding pre-applications), where the applicant received
training from a
California Board approved school must submit a Proof of Training Document. Please do
not send your diploma or
transcripts.
LOCATION PREFERENCE
Indicate whether you wish to take your examination at either the Board’s Glendale or Fairfield
examination site.
LANGUAGE PREFERENCE
Indicate the language you would like to take your examination. All written examinations and practical
instructions are
offered in English, Spanish, Korean and Vietnamese. Please note: These
examinations are translated into the most universal or neutral version of each language to be
acceptable to the widest possible audience.
REASONABLE ACCOMMODATION
The Board provides reasonable accommodations for applicants with learning or physical disabilities that
will affect their ability to take the
required licensing examinations. Applicants requiring a reasonable
accommodation must complete a Request for Reasonable Accommodation form and all supporting
documentation with this application. This form must be completed by a medical professional and
returned to
the Board with any necessary medical documentation for approval before an examination
date can be scheduled. If you wish to provide your own reader for the exam, please complete an
Application to use an Interpreter or Interpreter/Model Forms G & H with this application and two identical
1
1/2" x 1 1/2" photos.
INTERPRETER OR INTERPRETER/MODEL
The Board allows for use of an interpreter or interpreter/model. Each applicant
must have prior
authorization from the Board to use an interpreter or interpreter/model during the examination. The
applicant must complete an Application to use an Interpreter or Interpreter/Model Forms G & H with this
application. Indicate if you will be using an interpreter (for the written
exam) or an interpreter/model
(for both the written and practical exams) and indicate your native language. The interpreter or
interpreter/model must complete Interpreter or Interpreter/Model Form H and provide two identical
1 1/2"
x 1 1/2" photos, signed on the back by the interpreter or interpreter/model. Both forms must be
submitted with the
application for examination. Note: An interpreter/model can only be used for the
Barber or Electrology practical exams. However, an interpreter may
be used for both parts of the
examination for the Cosmetology, Esthetician, or Manicurist if you qualify for the use of an
interpreter.
You cannot change interpreters or interpreter/models unless a new application and photographs are
received and approved by the Board at least 15 days prior to your scheduled examination date.
Please refer to "Interpreter or Interpreter/Model Instructions” to
determine if you meet the
qualifications for use of an interpreter or interpreter/model.
Form #F-34555-BOC (Revised November 2020) Page 6 of 7
OUT OF STATE
If you hold a license in another state, request that state send a Certification of Licensure directly to
the Board. If you are licensed in more than one state, you may elect to submit a certification request
to one or all of the states of
your choice. Should your certification arrive at the Board before your
application, it will be kept on
file for one year. Please note some states charge a fee to certify your
license, and you are responsible for the incurred
expense. California requires the following hours of
training: Barber= 1,500 Cosmetology= 1,600 Esthetician= 600 Manicurist= 400 Electrology= 600
If you don’t meet the hours of training required for California, you must submit an Out-of-State
Applicant Affidavit of Experience – Form C to the Board along with your Application for Examination,
appropriate fee, and other required documents. Each 3 months of licensed practice shall be
deemed the equivalent of 100 hours of training
for exam qualification.
If you never received a license, but studied in another state, submit an Out-of-State Applicant School
Training Record – Form B and transcripts to the Board along with your Application for Examination,
appropriate fee, and other required documents. If your out of state school hours are insufficient,
you may complete additional training at an out of state or California Board approved school.
RECIPROCITY
The Board shall grant a license without an examination to an out of state applicant if the
applicant submits and verifies all of the
following to the Board:
(a)
A completed application form and all fees required by the Board.
(b)
Proof of a current license issued by another state to practice that meets all of the following
requirements:
(1)
It is not revoked, suspended, or otherwise restricted.
(2)
It is in good standing.
(3)
It has been active for 3 of the last 5 years, during which time the applicant has not
been subject to
disciplinary action or a criminal conviction.
TO APPLY FOR RECIPROCITY, YOU MUST COMPLETE THE APPLICATION FOR RECIPROCITY
& INITIAL LICENSE FEE. RECIPROCITY CANDIDATES ARE SUBJECT TO ONLY THE LICENSE
FEE AS NO EXAMINATION FEE IS REQUIRED (please be advised the reciprocity license fee is
only refundable if the applicant is ineligible for that license type and you choose not to apply
the fee to a different license type or towards the exam fee). Florida Full, Facial, and Nail
Specialist licenses do not qualify for Reciprocity.
HELPFUL APPLICATION HINTS
• Make sure your application is completely filled out. Incomplete application will be returned to you
and will delay in the processing of your application and the scheduling of your examination.
• Double check your address (please notify the Board immediately via email* if your address
changes at any time).
• Double check your exam location and exam language (notify the Board immediately via email* if
not correct).
• Include a copy of your valid government issued photo ID (this helps the Board verify your name
and address).
• Pay by check (it will help you track your application status).
• If you have any questions about the status of your application, please first verify your check has
been cashed. Please allow 12 weeks before inquiring about the status of your application after
your check has been cashed.
• If you require an interpreter or interpreter/model, complete and attach an Application to use an
Interpreter or Interpreter/Model Forms G & H.
• If you need a reasonable accommodation, complete and attach a Request for Reasonable
Accommodation form.
Form #F-34555-BOC (Revised November 2020) Page 7 of 7
EXAMINATION INFORMATION
• It takes between 2 and 8 weeks for your application to be approved and for you to receive an
admission letter.
• Your exam will be scheduled 25 to 40 days after you get your admission letter.
• Once you have been scheduled to take the practical portion of the exam, the practical exam
date cannot be changed.
• If you do not hear from the Board within 3 months of submitting your application, please email*
the Board regarding the status of your application.
• Notify the Board via email* if you need to update your address after you submit your
application.
• The Boards rules and regulations can be downloaded from
http://www.barbercosmo.ca.gov/laws_regs/index.shtml.
• Please go to the “APPLICANTS” section on the Board’s website and click on the “Examination
Information” link for valuable examination information that will help you prepare for your
examination including the following information:
Candidate Information Bulletins (provides candidates with a comprehensive overview of the
examination including the verbal instructions read, the tasks to be performed that will be graded
for the practical examination, and list of supplies).
Frequently Asked Questions (including practical examination, general examination, mannequin,
and tri-pod questions).
NIC Webcast (gives step by step instructions for the practical examination including a Q & A
section).
*Email - barbercosmo@dca.ca.gov
All forms and applications referenced in this application can be found on the Board’s
website at www.barbercosmo.ca.gov under “FORMS/PUBS”.
(Revised January 2015)
INFORMATION COLLECTION, ACCESS AND DISCLOSURE
The Information Practices Act, Sec. 1798.17 Civil Code, requires the following information to be
provided when collecting information from individuals.
AGENCY NAME
Board of Barbering and Cosmetology
TITLE OF OFFICIAL RESPONSIBLE FOR INFORMATION MAINTENANCE
Executive Officer
ADDRESS
2420 Del Paso Road, Suite 100, Sacramento, CA 95834
INTERNET ADDRESS
www.barbercosmo.ca.gov
TELEPHONE AND FAX NUMBERS
(916) 574-7570 phone (916) 575-7281 fax
AUTHORITY WHICH AUTHORIZES THE MAINTENANCE OF THE INFORMATION
Sections 7300 to 7457, inclusive, comprising Chapter 10 Division 3, of the California Business and
Professions Code.
CONSEQUENCES OF NOT PROVIDING ALL OR ANY PART OF THE REQUESTED
INFORMATION:
It is mandatory that you provide all information requested. Omission of any item of requested
information will result in the application being rejected as incomplete.
PRINCIPAL PURPOSE(S) FOR WHICH THE INFORMATION IS TO BE USED
The information requested will be used to determine qualifications for licensure or certification to
determine compliance with the group and corporate practice provisions of the law and to establish
positive identification.
ANY KNOWN OR FORESEEABLE DISCLOSURES WHICH MAY BE MADE OF THE
INFORMATION
Your completed application becomes the property of the board and will be used by authorized
personnel to determine your eligibility for a license or certification. Information on your application may
be transferred to other governmental or law enforcement agencies. Pursuant to the California Public
Records Act (Gov. Code Section 6250 et seq.) and the Information Practices Act (Civ. Code Section
1798.61), the names and addresses of persons possessing a license or registration may be disclosed
by the department unless otherwise specifically exempt from disclosure under the law. Consequently,
the personal name and address information entered on the attached form(s) may become
public information subject to disclosure.
BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY ● GAVIN NEWSOM, GOVERNOR
DEPARTMENT OF CONSUMER AFFAIRS ● BOARD OF BARBERING AND COSMETOLOGY
P.O. Box 944226, Sacramento, CA 94244-2260
Phone (800) 952-5210 Email: barbercosmo@dca.ca.gov
Website: www.barbercosmo.ca.gov
(Revised January 2015)
SOCIAL SECURITY NUMBER (SSN) OR INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER
(ITIN) DISCLOSURE
Disclosure of your SSN or ITIN is mandatory. Section 30 of the Business and Professions Code and
Public Law 94-455 [42 U.S.C.A. Section 405(c)(2)(C)] authorizes collection of your SSN or ITIN. Your
SSN or ITIN will be used exclusively for tax enforcement purposes, for purposes of compliance with
any judgment or order for family support in accordance with section 17520 of the Family Code, or for
verification of licensure or examination and where licensure is reciprocal with the requesting state. If
you fail to disclose your SSN or ITIN, you will be reported to the Franchise Tax Board, which may
assess a $100 penalty against you.
TAXPAYER INFORMATION
Effective July 1, 2012, the State Board of Equalization and the Franchise Tax Board may share
taxpayer information with the board. You are obligated to pay your state tax obligation and your license
may be suspended if the state tax obligation is not paid.
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(1002) COSMETOLOGIST APPLICATION FOR EXAMINATION AND INITIAL LICENSE (California)

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