NAME:    
               FIRST                                          MIDDLE                        LAST

HOME ADDRESS:  
 
PHONE #

WORK ADDRESS:
 
PHONE #

U.S. CITIZEN YES  NO

SS#

DATE OF BIRTH: 

PLACE OF BIRTH:  

SEX:   HEIGHT:   WEIGHT:   HAIR:  
EYES:

PREVIOUS ADDRESS, IF AT PRESENT ADDRESS LESS THAN 5 YEARS:

ADDRESS, CITY, STATE & ZIP
 

I WORK AS:       INDEPENDENT   GOVERNMENT           SECURITY            
(PLEASE CHECK               LOCKSMITH                      EMPLOYEE                   CONSULTANT           
ONLY ONE)                   
                                           INDUSTRIAL-         OTHER
                                 INSTITUTIONAL
                                             SECURITY

HAVE YOU READ THE   YES  NO       
BY-LAWS?

DO YOU UNDERSTAND THE  YES  NO
BY-LAWS?  

IF NO, WHAT DON'T YOU UNDERSTAND?

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 BONED?  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EVER BEEN REVOKED OR SUSPENDED IN ANY STATE?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 BEEN CONVICTED OR ANY OFFENSE IN
IOWA OR ANY OTHER STATE OR IS 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 ABOVE 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:

REFERENCES:  List the names & address of three (3) people (not related to you)
who can attest to your reputation for honesty & fair character, experience & ability.

NAME:

ADDRESS:
                    CITY, STATE & ZIP

BUSINESS PHONE #:    HOME PHONE #:

NAME:

ADDRESS:
                    CITY, STATE & ZIP

BUSINESS PHONE #:    HOME PHONE #:

NAME:

ADDRESS:
                    CITY, STATE & ZIP

BUSINESS PHONE #:    HOME PHONE #:

ARE YOUR FINGERPRINTS ON FILE ANYWHERE?  YES  NO 
IF SO WHERE?

SPONSORED BY (ILA, ALOA Member of Trade Business)
DATE:

Include with this application form, a copy of a local & state police background check that
covers the last five (5) years.  If you recently moved to Iowa, include a police background
check from your previous law enforcement agency.

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 Iowa Chapter of ALOA.

SIGNED_________________________________ DATE _____________

I AM APPLYING FOR THE FOLLOWING MEMBERSHIP

     ACTIVE MEMBER

THE FOLLOWING ARE THE ANNUAL DUES:

                   ACTIVE MEMBER     $55.00

                  APPLICATION FEE $15.00
                 

RETURN THE APPLICATION AND THE ONE (1) YEARS ANNUAL DUES PLUS THE APPLICATION
FEE TO Roger Hamilton, Address is located at the bottom of this application!

APPLICANT- DO NOT WRITE BELOW THIS LINE

DATE APPLICATION RECEIVED______________  BY_____________________________

DATE DUES RECEIVED ______________________BY______________________________

DATE OF FIRST READING_______________ DATE OF SECOND READING___________

DATE APPLICATION ACCEPTED______________ BY______________________________

DATE APPLICATION REJECTED______________ BY______________________________

DATE DUES RETURNED _____________________ BY______________________________

MEMBERSHIP NUMBER _______________

COMMENTS:

Please send all applications & checks to:

Roger Hamilton
309 Montgomery St
Decorah, IA 52101

* Please make all checks payable to:
Iowa Chapter of ALOA