The Missouri-Kansas Locksmith Association Application for Membership The Missouri - Kansas Locksmith Association P.O. Box 12493 N. Kansas City, Mo. 64116 The Missouri-Kansas Locksmith Association, Inc. is an association of locksmiths whose purpose and object is to encourage, promote, aid in and affect the voluntary interchange among the membership of data, information, experience, ideas, knowledge methods, and techniques relating to the field of locksmithing. All members pledge to conduct themselves in a dignified manner, to avoid using any improper or questionable methods of soliciting professional work and to decline patronage. Members further pledge to promote public welfare, always ready to apply their special knowledge, skill, and training for the use and betterment of the craft. NAME:_____________________________________________________________ FIRST MIDDLE LAST HOME ADDRESS: ___________________________________________________ PHONE # (_______) ______________________ WORK ADDRESS: ___________________________________________________ PHONE # (_______) ______________________ U.S. CITIZEN YES _____ NO _____ DATE OF BIRTH: _____ - ______ - __________ PLACE OF BIRTH: __________________________________________________ SEX: M____ F ____ HEIGHT: ______WEIGHT:______ HAIR: _________ EYES: ______________ PREVIOUS ADDRESS, IF AT PRESENT ADDRESS LESS THAN 5 YEARS: ____________________________________________________________________ ADDRESS, CITY, STATE & ZIP I WORK AS: (PLEASE CHECK ONLY ONE) _____ INDEPENDENT LOCKSMITH _____ GOVERNMENT EMPLOYEE _____ SECURITY CONSULTANT _____ INDUSTRIAL LOCKSMITH _____ INSTITUTIONAL SECURITY _____ OTHER Please Give Description. __________________________________ Please circle one answer. ARE YOU CURRENTLY A MEMBER OR, OR HAVE BEEN A MEMBER OF ANY SAFE-LOCK RELATED ORGANIZATION? YES NO LIST ORGANIZATION & GIVE MEMBERSHIP # ______________________ ___________________________________________________________________ ARE YOU CURRENTLY LICENSED OR BONDED? YES NO HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES NO HAVE YOU EVER BEEN LICENSED IN ANY OTHER STATE AS AN OWNER, MANAGER OR EMPLOYEE OF A LOCKSMITH BUSINESS? YES NO HAVE YOU EVER HAD A SECURITY CLEARANCE SUSPENDED, DENIED OR REVOKED? YES NO HAS YOUR APPLICATION FOR A LICENSE AS AN OWNER, MANAGER OR EMPLOYEE OF A LOCKSMITH BUSINESS EVER BEEN REFUSED? YES NO HAS YOUR LICENSE AS AN OWNER, MANAGER OR EMPLOYEE OF A LOCKSMITH BUSINESS EVER BEEN REVOKED OR SUSPENDED IN ANY STATE? YES NO HAVE YOU OR MEMBERS OF YOUR BUSINESS, EVER BEEN CONVICTED OR ANY OFFENSE IN MISSOURI, KANSAS OR ANY OTHER STATE OR ARE THERE ANY CRIMINAL CHARGES AGAINST YOU OR ANY MEMBERS OF YOUR BUSINESS NOW PENDING (OTHER THAN MINOR TRAFFIC VIOLATIONS, ETC)? YES NO IF YOU ANSWERED YES TO ANY OF THE LAST FOUR QUESTIONS GIVE DETAIL: EMPLOYMENT HISTORY: Complete the following for the entire period of the past five (5) years. List most recent first. EMPLOYER'S NAME: EMPLOYERS ADDRESS: NATURE OF BUSINESS: DATE OF EMPLOYMENT FROM: TO: EMPLOYER'S NAME: EMPLOYERS ADDRESS: NATURE OF BUSINESS: DATE OF EMPLOYMENT FROM: TO: EMPLOYER'S NAME: EMPLOYERS ADDRESS: NATURE OF BUSINESS: DATE OF EMPLOYMENT FROM: TO: EMPLOYER'S NAME: EMPLOYERS ADDRESS: NATURE OF BUSINESS: DATE OF EMPLOYMENT FROM: TO: EMPLOYER'S NAME: EMPLOYERS ADDRESS: NATURE OF BUSINESS: DATE OF EMPLOYMENT FROM: TO: REFERENCES: List the names & address of two (2) people (not related to you) who can attest to your reputation for honesty & fair character, experience & ability who are not members of MKLA. NAME: ADDRESS:________________________________________________________ CITY, STATE & ZIP BUSINESS PHONE #: HOME PHONE #: NAME: ADDRESS:_________________________________________________________ CITY, STATE & ZIP BUSINESS PHONE #: HOME PHONE #: MKLA MEMBER SPONSOR: List below the MKLA Member who is recommending you for membership. NAME: ADDRESS:_________________________________________________________ CITY, STATE & ZIP BUSINESS PHONE #: HOME PHONE #: ARE YOUR FINGERPRINTS ON FILE ANYWHERE? YES NO IF SO WHERE? I AM APPLYING FOR THE FOLLOWING MEMBERSHIP _______ Active. Active members shall be those individuals that are engaged in installing and servicing security hardware. Active members shall be accorded all rights, privileges, and obligations of MKLA membership. _______Associate. Associate membership is available to those manufacturing and/or companies engaged in supplying material, equipment, or services to the locksmith, security, and/or safe industry or profession. THE FOLLOWING ARE THE ANNUAL DUES: ACTIVE MEMBER $40.00 ASSOCIATE MEMBER $70.00 I STATE THAT ANY & ALL INFORMATION GIVEN ON THIS APPLICATION IS TRUE & CORRECT. I UNDERSTAND THAT MY MEMBERSHIP MAY BE CANCELLED AT ANY TIME IF ANY INFORMATION FOUND HEREIN IS FALSE & ALL MONIES ARE FORFEITED. I FURTHUR STATE, THAT I WILL ABIDE BY THE RULES, REGULATIONS & BY-LAWS OF THE MISSOURI-KANSAS LOCKSMITH ASSOCIATION. SIGNED_________________________________ DATE _____________ PLEASE RETURN THE APPLICATION AND THE ONE (1) YEARS ANNUAL DUES TO The Sergeant At Arms c/o The Missouri - Kansas Locksmith Association P.O. Box 12493 N. Kansas City, Mo. 64116 APPLICANT - DO NOT WRITE BELOW THIS LINE ________________________________________________________________________ DATE APPLICATION RECEIVED______________________BY______________________________ DATE DUES RECEIVED ______________________BY______________________________ DATE APPLICATION PRESENTED TO BOARD _____________________ DATE APPLICATION PRESENTED TO MEMBERS __________________ WAS APPLICATION ACCEPTED___________REJECTED_____________ MEMBERSHIP NUMBER _______________ COMMENTS: Copyright © Missouri- Kansas Locksmith Association All Rights Reserved.