I(i-BarberCO:;IllO

BOARD OF BARBERING AND COSMETOLOGYP.O. Box 944226, Sacramento, CA 94244-2260P (800) 952-5210 F (916) 575-7281 www.barbercosmo.ca.gov

DON XIN KHOI PHUC GIAY PHEP BI THU HOI(B9 lu~t Kinh doarili va NghS nghiep muc 11522)

MUC A: THONG TIN cA NHAN

Nam

So An sinh xil hQi hoac So Khai thu6 ca nhan Ngay sinh

DO-DO-DODDDDD -DD -DDDD Thang NgayTen

Thanh ph6 Bang Mil buu chinhDia chi cu tru

Dia chi E-mailse dien thoai se Gifry phep lai xe CA

Quy vi hien co viec lam hay khong? 0 Khong 0 Co N~u co, vui long diSn vao Muc B ben diroi.

MUC B: THONG TIN NGHE NGHIEP HIEN TAl (n~u co)Dia chi kinh doanh hien tai Thanh pho Bang Mil buu chinh

H9 cua Nha tuyen dung Ten

Bang Mil buu chinhThanh ph6Dia chi hop thir cua Nha tuyen dung

Dia chi E-mail cua Nha tuyen dungSo dien thoai cua Nha tuyen dung

MUC C: QuA TRiNH LAM VIEC [k~ tir ngay co hi~u luc thuc hi~n thu h6i gi§y phep cua quy vj]

Vui long dinh kern danh sach cac nha tuyen dung tnroc day, li~t ke ten cong ty, dia chi, s6 dien thoai, nguoi lien Mva ngay tuyen dung.

MUC D: THONG TIN LuAT SU (n~u co)

Bang Mil buu chinhThanh ph6Dia chi hop thu cua Luat str

Dia chi E-mail cua Luat suSo di~n thoai cua Lu~t sir

MVC E: THONG TIN GIA.y PHEP

Gifry phep loai: Gifty phep #:

sa quyet djnh Ngay hi~u IIrcLoai va sa gj§y phep b] thu h6i muon khoj phuc (li~t ke t§t ca)

Giay phep loai: Gifry phep #:

Gifry phep loai: GifrY phep #:

Gifry phep loai: GifrY phep #:

PetReins (SCPadbi Thanq chin 2015) Trang 1/3

MVC F: UiJ TIEN DlEV TRA.N

Ngay

Dja di~m 1I'U tien

DMi~D B~c California

DMi~D Nam California

D C6 s~n ban dfru

NgOD Dgfr 1I'U tien

D TiSng Anh D TiSng Vi~t

D TiSngHl'm

D KMc (vui long ghi r5): _

D TiSng ray Ban Nha

Ml)C G: THONG TIN LY LJCH [k~ tir ngay co hi~u II}'C thuc hi~n thu h&igi~y phep cua quy vj]

1. Quy vi co tirng bi kSt an hoac khong choi t9i, vi pham lu~t phap cua Hoa Ky, o·bit ky bang, chinh quyen dia phuong nao,hay bfrt ky mroc nao, kS ca viec khong choi t9i hoac kSt an bi bai bo sau do (khong bao gorn cac hanh vi vi pham giao thongbi phat 300$ hoac it hon) khong? D Khong D Co N~u co, hay dinh kern tfrt ca cac tai li~u cua Toa An va cac chi tiet, giaithich vS hanh vi pham t9i.

2. Quy vi co tirng bi quan chS hlnh SlJ hoac tarn tha khong? D Khong D Co N~u co, hay dinh kern Lenh Tea An.

3. Quy vi c6 tung diroc yeu du dang ky vao danh sach nhirng nguoi pham t9i tinh due khong? D Khong D Co N~u co,hay dinh kern Lenh Toa An.

4. Hien tai quy vi co bfrt ky t9i hlnh SlJ nao dang cho giai quyet hay khong? D Khong D Co N~u co, hay dinh kern cac chitiSt, giai thich vS t9i trang, va ban mo ta cac SlJ kien va hoan canh d§n dSn toi trang.

5: Quy vi co bfrt ky gifry phep chuyen mon hoac hanh nghe hoac h6 so dang ky nao bi nr choi, dinh chi, thu h6i, tlnr thachhoac bfrt ky bien phap kY luat khac duoc thuc hien boi bit ky CO' quan chinh phu nao khac o·tiSu bang nay hoac bfrt ky tiSubang khac, hoac bfrt ky mroc ngoai nao khong?

DKhong 0 Co N~u co, vui long dinh kern mot ban sao (cac) hanh vi hanh chinh, va cac chi tiSt, giai thich vS bien phap kYluat,

Ml)C H: TVAN' THU HI:¢N T4-I

Xin dinh kern rnQt mf ta v~ nhfrng gi quy vi dil thuc hi~n d~ t\f cai hu~n theo cac tieu chi quydjnh trong Quy ch~ cua BQ lu~t California muc 971 va b~t ky tai Ii~u hB trg nao cho nB I\fCcai hu~n ciia quy vi.MVC I: tic NH~N CUA NGUCjJ N<)P DONT6i xdc nhdn rling toi aa age va hdu cac ludt va quy dinh lien quan ain nghi?p v~ nay o' California. T6i xin eam doan niukhai man se hi phat theo ludt cua Tdu bang California rang ttit ca loi khai duac eung dip e6 lien quan ain arm nay la dungsic thdt va ehinh xae.

Kyten

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'(XBarberCosmo

BOARD OF BARBERING AND COSMETOLOGYP.O. Box 944226, Sacramento, CA 94244-2260P (800) 952-5210 F (916) 575-7281 www.barbercosmo.ca.gov

THU TH~P, TRUY NH~P vA TIET LO THONG TINDao lu~t Thuc hanh Thong tin, Muc, 1798.17 BQ luat Dan sir, yeu diu cac thong tin sau phai diroc cung d.p khi thu th~pthong tin tir cac ca nhan.

TENCOQUANH9i d6ng Lam t6c va Th~m my (Board of Barbering and Cosmetology)

CWC VV CUA cAN BQ CIqU TRAcH NIII¥M BAo QUAN THONG TINCan b9 diSu hanh

DJACHi2420 Del Paso Road, Suite 100, Sacramento, CA 95834

DJA CHi INTERNETwww.barbercosmo.ca.gov

SO DI~N THO~I vA. so FAX(916) 574-7570 dien thoai (916) 575-7281 fax

CO QUAN iN QUYEN BAo QUAN THONG TINCac muc 7300 d6n 7457, d.t ca, bao g6m Chirong 10 Doan 3, cua B9 luat Kinh doanh va NghS nghiep California.

~U Q~JA CUA ~C KHONG CUNG cAP TAT cA HO~C BAT KY PHAN NA.O CUA THONG TIN DU<}CYEUCAU:Vui long cung d.p t~t ca cac thong tin diroc yeu diu. Viec bo s6t b~t ky muc thong tin duoc yeu diu nao c6 th~ d~n d6n viecdon xin bi tir choi vi khong d~y duo

MUC ntcn cHiNH CUA VrEC sir DUNG THONG TINCa~ thong tin duoc yeu diu se d~'Q"Csir dung d~ xac dinh trinh d9 chuyen mon cho viec d.p giay phep hoac gi~y chungnhan, d~ xac dinh sir tuan thu voi cac quy dinh luat phap vS thuc hanh nhorn va cong ty va dS thiSt l~p nhan dang tich cue.

B.;\T KY cAc ~IET L<) DA nrsr HO~C Co THE mr D9AN DOl vor THONG TIN , "Ho sa dang ky day du cua quy vi se tro thanh tai san cua hoi dong va se duoc sir dung boi nguoi c6 tham quyen de xac dinhban c6 du diSu kien d~ diroc etlp gilly phep hoac chirng nhan hay khong. Thong tin vS h6 sa dang ky cua quy vi c6 th~ duocchuyen giao cho cac co quan chinh phu hoac co quan thuc thi phap Iuat khac. Can cir theo Dao luat H6 sa Cong congCalifornia (B9Iu~t Chinh quyen Muc 6250 et seq.) va Dao lu~t Thuc hanh Thong tin (B9 luat Dan SI! Muc 1798.61), ten vadia chi cua nguoi serhtru gi~y phep hoac dang ky c6 th~ diroc ti6t 19boi co quan tnr tnrong hQ"Pd~c biet duoc miSn ti6t Ie>theo luat phap. Do do, ten va dja chi thong tin ca nhan dlfQ'Cdi~n vao (cac) rnftu don dinh kern co th~ trO' thanh d&itlfQ'ng thong tin cong cQng dUQ'cti~t IQ.

TrET L(> so AN SINH xA H(>I (SSN) HO~C SO KHAI THUE cA NIlAN (ITIN)Viec ti6t Ie> SSN hoac !TIN cua quy vi la bilt bU9C.Muc 30 cua B9 lu~t Kinh doanh va NghS Nghiep va Cong Luat 94-455[42 USCA Muc 405 (c)(2)(C)] cho phep thu thap SSN hoac ITIN cua quy vi. SSN hoac ITIN cua quy vi se duoc sir dungdanh rieng cho muc dich cuong ch6 thue, cho muc dich tuan thu bllt ky phan quyet hoac lenh h6 tro gia dinh theo muc17520 Bc luat Gia dinh, hoac dS xac minh clip gilly phep hoac ki~m tra va nai etlp gi~y phep Ill.d6i irng voi bang yeu c~u.NSu khong khai bao SSN hoac ITIN, quy vi se bi bao cao dSn So' ThuS vu Ti~u bang (Franchise Tax Board), va c6 thS biphat $100.

THONG TIN NGUOl NOP THUEC6 hieu lire ngay 1 thang bay nam 2012, H9i dong Quan binh ThuS vu Ti~u bang (State Board of Equalization) va So' ThuSvu Ti~u bang (Franchise Tax Board) c6 th~ chia se thong tin nguoi n9P thu6 voi hQi d6ng. Quy vi c6 nghia vu phai nop thueva gi~y phep cua quy vi c6 th~ bi dinh chi n6u nghia vu thue bang khong ducc thuc hien,

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BliSI\ESS, CO\SL\lER SERVICES.'\ \0 IIOrSPiG AGE;\CY • GOVER;\OR EO"I'\D G. BROW\ .11(.

BOARD OF BARBERING AND COSMETOLOGYP.O. Box 944226, Sacramento, CA 94244-2260

BarberCosmo P (800) 952-5210 F (916) 575-7280 www.barbercosmo.ca.gov

csc MUC CUA BO LUAT Ap DUNG £lIEU cHiNH. KIEN NGH! KHOI Pt-U,JC,

vA TIEU CHi CHO VII;C KHOI PHVC

*11522. Ki~n nqh] Kh6i phuc

MQt ngll'oi co gi&y phep b] thu h6i hoac dinh chi co quy~n ki~n nqh] vai co quan d~ kh6i phuc hoacgiam hinh phat sau mQt khoanq thoi gian da qua kh6ng it hon met narn k~ tu. ngay quy~t djnh co hi~u IlfChoac k~ tu. ngay don ki~n nqh] tll'O'ng tlf b] tu. chOi. Co quan nay se th6ng bao cho T6ng chU'ang Iy ve ho so kiennghi va T6ng chU'ang Iy va nguyen don se c6 co hoi trlnh bay lap luan, bang mi$ng hoac bang van ban truce coquan. Co quan nay se quyet dinh viec kien nghi, va quyet dinh nay se bao gom Iy do, b~t ky dieu khoan ve dieu kiennao rna co quan nay cho la hop Iy de ap d~t nhU' mot dieu kien de kh6i phuc. Phan nay kh6ng duoc ap dunq neu cacquy ch~ danh cho co quan rieng biet c6 cac quy dinh khac ve viec kh6i phuc hoac giam hlnh phat.

**971. Cac tieu chi cho viec kh6i phuc(a) Khi xem xet tCYch6i cap gi~y phep, theo Muc 480 cua Bo t.uat Kinh doanh va Nghe nqhiep, d6i v&i ho so

da dU'Q'cthuc hien theo Chuonq 10, Khoan 3 Bo Luat Kinh doanh va Nghe nqhiep, hQi dong, trong viecdanh gia kh6i phuc cho ngU'cYinop don va tlnh du dieu kien hien tai cua ho de cap phep, phai xem xetcac tieu chi sau:(1) Tinh chat va m(vc dQ nghiem trQng cua hanh vi hoac tQi tr~ng dang dll'Q'c xem xet d~ lam can

c(v tu. chOi.(2) B~ng ch(vng v~ bat ky hanh vi vi pham ti~p theo hanh vi hoac tQi tr~ng dang dll'Q'c xem xet

lam can c(v tu. chOi, di~u nay cung co th~ dll'Q'c xem la can c(v tu. chOi theo Ml:lc 430 hoac BQlu~t Kinh Doanh va Ngh~ Nghi~p.

(3) Thoi gian da qua k~ tu. ngay thlfc hi~n hanh vi ho~c tQi tranq dll'Q'c tham chi~u & phan doan(1) ho~c (2).

(4) M(Vc dQ ma ngll'oi nQp don da tuan thu dOi vai b&t ky di~u khoan tarn tha, thiP thach, b6ithll'ong, hoac bat ky bi~n phap xiP phat hop phap khac chOng I~i ngll'oi nQp don.

(5) B~ng ch(vng, n~u co, v~ vi~c kh6i phuc dll'Q'c d~ trinh boi ngll'oi nQp don

(b) Khi xem xet dinh chi hoac thu h6i gifly phep, ban hanh theo Chu'o'nq 10, Khoan 3 B9 l.uat Kinh doanh vaNghe nghi$p theo Muc 490 cua cunq be luat, hol dong, trong viec danh gia kh6i phuc cua nquoi do vatfnh du dieu kien hien tai cua ho de cap phep, phai xem xet cac tieu chi sau:(1) Ban chat va rmrc do nqhiern trong cua hanh vi hoac vi pharn.(2) Toan bo Iy lich tU' phap.(3) Thoi gian da qua ke tCYnqay thuc hien hanh vi hoac vi pharn.(4) NgU'cYiduoc cap phep c6 tuan thu bat ky dieu khoan tarn tha, thu>thach, boi thU'cYng,hoac bat ky bien

phap xU>phat hop phap khac ch6ng l<;lingU'cYidU'Q'Ccap phep hay kh6ng.(5) Bang chtrnq, neu c6, ve thu tuc huy ho so tien an theo Muc 1203.4 Bo luat Hlnh su.(6) Bang chunq, n~u c6, ve viec kh6i phuc ducc d$ trlnh bai ngU'cYidU'Q'ccap phep.

(c) Khi xem xet don xin kh6i phuc giay phep, hOi dong phai dsnh gia bang chirnq kh6i phuc cua ngU'cYikiennghi, xem xet nhCl'ngtieu chi kh6i phuc dU'Q'cquy dinh tai tieu rnuc (b).

* BO lu$t Chinh phu, Tieu de 2, Khoan 3, Phan I, Chuonq 5** BO luat Quy che California, £)ieu 16, Khoan 9