The Maryland Lottery License form is essential for individuals seeking employment in the video lottery gaming industry. This application must be completed by anyone who has received a conditional job offer from a licensed facility operator and will be involved in various gaming-related duties. To get started, please fill out the form by clicking the button below.
The Maryland Lottery License form is an essential document for individuals seeking employment in the video lottery gaming industry. This application is specifically designed for those who have received a conditional job offer from a licensed facility operator, manufacturer, or contractor. It outlines the responsibilities and qualifications required for various positions related to the operation of video lottery terminals and associated equipment. The form requires detailed personal information and must be completed accurately to avoid any potential denial of the application. Notably, the applicant must submit their fingerprints and a recent photograph as part of the application process. Additionally, the sponsoring licensee, who holds a Maryland Video Lottery Manufacturer, Operator, or Contractor Gaming License, plays a crucial role in the submission process. They are responsible for certifying the application before it is sent to the Maryland State Lottery Commission. Applicants should be aware that the application and related fees are non-refundable, and any false statements can lead to serious consequences, including denial or revocation of the gaming license. Understanding these key aspects is vital for a smooth application process and successful entry into the gaming industry.
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Sponsored Gaming Employee License Application
Maryland State Lottery Commission
MARYLAND STATE LOTTERY COMMISSION
VIDEO LOTTERY GAMING EMPLOYEE LICENSE APPLICATION
I.INDIVIDUALS REQUIRED TO OBTAIN A VIDEO LOTTERY GAMING EMPLOYEE LICENSE:
a.This application must be completed by an individual who has received at least a conditional offer of employment from a licensed facility operator, manufacturer or contractor as a video lottery employee, and whose duties relate or will relate to the operation of a facility, and who performs or supervises or will perform or supervise the performance of: (1) operating, servicing, or maintaining a video lottery terminal or associated equipment; (2) accounting, maintaining, or auditing a facility’s financial records; (3) counting or processing video lottery terminal revenue; (4) conducting security or surveillance in or around a facility; (5) operating or maintaining a facility’s information systems; (6) is employed by a contractor or manufacturer, whose duties directly relate to the repair, service or distribution of a video lottery terminal and associated equipment, or is otherwise required to be present on a facility’s gaming floor or in a restricted area of a facility; or (7) is otherwise required by the Commission to be licensed as a gaming employee. Examples of gaming employees may include, but are not limited to: booth operators, slot machine mechanics, count room employee, cage employee, security and surveillance personnel, auditing and accounting employees, or information technology employees.
b.An individual who is employed by licensee described above whose duties will be other than the duties described in (a) above are not required to obtain a gaming employee license. Those individuals are required to obtain a non-gaming license.
II.COMPLETING THIS FORM:
Sponsoring Licensee’s Responsibilities
a.This form is to be used only when a holder of a Maryland Video Lottery Manufacturer, Operator or Contractor Gaming License (sponsored licensee) makes application for an employee applicant who has been offered a position within the sponsored licensee business.
b.The form will be filled out by the applicant employee not the sponsored licensee. The sponsored licensee is responsible for completing the Certification of Sponsored Licensee at the end of this application.
c.The form must be submitted to the Commission by the Sponsored Licensee not the applicant employee.
Applicant Employee’s Responsibilities
d.You are to complete this form and submit it to the sponsored licensee for submission to the Commission.
e.You must make accurate statements and include all material facts. Any misrepresentation, or the failure to provide requested information, may result in the denial of your application.
f.Read each question carefully prior to answering. Answer every question completely. Do not leave blank spaces. If a question does not apply to you or you have nothing to disclose, indicate “Does Not Apply” in response to that question. Failure to provide a response to every question could result in the denial of your application.
g.If the space available is insufficient to respond to a question, supply the required information on an attachment page and clearly identify which question you are answering.
h.If you make any modification to the pre-printed questions or information contained in this form, your application may be denied. Once your application is submitted, it becomes the property of the Maryland State Lottery Agency and will not be returned.
III. BE SURE:
a.You sign the Statement and Authorization at the end of this form in the presence of a notary.
b.You retain a completed copy of your application for your own records.
IV. PHOTOGRAPH AND FINGERPRINTS
VLT Form 2003 (Rev July 21,2011)
Page 2 of 14
Initials
a.You will be required to have your photograph taken when your application is made.
b.You will be required to submit fingerprints upon application.
V.NOTICES
a.A Maryland gaming license is a privilege. The burden of proving and maintaining qualifications to receive and hold a gaming employee license is at all times on the applicant.
b.Any false statement made in this application will reflect on your character and may result in the denial of your application or, if you receive a license based on a false statement, may result in suspension or revocation of your license.
c.When the Commission completes its background investigation and you are found qualified for a Maryland license this license will automatically convert to a video lottery employee gaming license. Should you not be found qualified your sponsored gaming employee license will become the subject of revocation and suspension proceedings before the Commission.
NOTE: AN APPLICATION THAT HAS BEEN ACCEPTED FOR FILING AND ALL RELATED MATERIALS SUBMITTED TO THE COMMISSION SHALL BECOME THE PROPERTY OF THE COMMISSION AND WILL NOT BE RETURNED TO THE APPLICANT.
APPLICATION AND REGISTRATION FEES
1.
Application fee
$ 250.00
2.
Finger print processing fee
$ 37.25
3.
License fee
$ 150.00
4.
Initial term
3 Year
5.
Renewal fee
$150.00
6.
Renewal term
Note: License, Application & Fingerprint fees are due at the time of application. They are
non-refundable. You may wire transfer your payment or mail it to the following address:
DO NOT MAIL APPLICATION AND PAYMENT TOGETHER!!!
Mail payment to:
Maryland State Lottery Agency
Attn: Support Services
1800 Washington Blvd, Suite 330
Baltimore, Maryland 21230
Mail the application to the same address, except: Attn: VLT Licensing Division.
PAYMENT FORM: MUST be sent as a certified/bank check or money order.
Page 3 of 14
Name of Gaming Licensee:
(You must have an offer to work from a Licensee :)
Type of Licensee
Operator
Manufacturer
Contractor
Position Applicant is Applying for:
Last Name
NAME AND ADDRESS
Suffix(Jr.. Sr., etc.)
First Name
Middle Name
Maiden Name
Date of Birth
Address Line 1
Address Line 2
P. O. Box
City
County
State/Province
Zip Code
Country
5. Email Address
6. Home Phone
7. Cell Phone
MAILING ADDRESS (If different from above)
8. Address Line 1
Email Address
Home Phone
Cell
DESCRIPTIVE INFORMATION
9.
Height
10. Weight
11.
Social Security Number
12. Driver’s License
FT
IN
lbs
State Issued:
13.
Do you have any tattoos, scars or distinguishing marks?
If yes,
14.
» IARITAL STATUS:
describe in detail:
SINGLE
MARRIED
15.
PLACE OF BIRTH:
SEPARATED
DIVORCED
City/Town
WIDOWED
DOMESTIC PARTNER
16.
Name of Spouse
17.
Spouse’s Maiden Name or
18. spouse
19.
Spouse’s Social Security' Number
AKA
DOB
20.
HAIR COLOR
21.
EYE COLOR
22.
SEX
23.
RACE*
Are y ou of Hispanic/Latino origin?
Yes
No
(BK)Black
(BR) Brown
(BK) Black
(M) Male
Caucasian
Black/African American
(BD) Blonde
(RD) Red
(HZ) Hazel
(BL) Blue
(F) Female
Native Hawaiian/Pacific Islander
Asian
(GY) Gray
(WH) White
(GR) Green
American Indian/Alaska Native О Other:
(BA) Bald
♦ Multiracial respondents may select all applicable racial
categories.
LIST ANY OTHER NAME OR NAMES YOU HAVE BEEN KNOWN BY (INCLUDE ALIASES. NICKNAMES. MARRIED NAMES)
24.Have you been known by any other name or names? О YES О NO If YES, list the additional names below and specify dates for use for each. Include maiden name, aliases, nicknames or any other names used.
LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
FROM
TO
DATE
VLT Form 2003 (Rev July 21, 2011)
Page 4 of 14
25.
Are you a United States citizen?
YES
NO
If NO, complete the following:
a.
Country of Citizenship:
Name and Address of sponsor
upon your arrival:
b.
If a naturalized citizen complete:
C.I.S. Registration Number:
2.Date Granted:
3.Court:
4.City/State of Court:
5.Certificate Number:
c. If you are a legally authorized Permanent Resident Alien, provide the “A" number from your Permanent Resident Card:
Card Number:
(Attach a color copy front and back)
d.If you do not posses a Permanent Resident Card but are authorized to work in the United States, please describe the U. S. Work Visa that you possess and provide the Visa number:
Description of Authorization:
VISA #:
26. Have you ever been issued a passport?
If, yes please complete the following:
Passport Number
Country of Issue
Place Issued
Date Issued
Expiration Date
DEPENDENTS
27.In the chart below, list the names of all your children, stepchildren and adopted children and the amount of support, if dependent. Also, list all other persons who you are supportin g or contributing to the support of, and provide the amount of support.
Name of Children/Dependent
Amount of
Present Address of
Support
Children/Dependents
Page 5 of 14
RESIDENCE
28.Beginning with your current residence(s) and working backwards, complete the following information for each place where you have lived (including residences while attending college or while in the military service) during the past ten (10) years or since the age Of 18, whichever is less. If additional space is needed, attach a separate sheet making
certain to indicate the question number.
Dates
Address
Own
Name, address & telephone no. of mortgage
From:
To:
(no, street, apt. #, City/town, state/province, zip
Or
company or landlord, if any
(Mo/Yr)
code
Rent
EDUCATION
29.Beginning with your highest level of education and working backwards complete the information listed below with respect to each school, college, graduate or postgraduate school you have attended, if additional space is needed,
attach a separate sheet making certain to indicate the question number.
Name and Address of
Description of
List any Degree
Graduated
School, Training program, etc.
Educational Program
or Certification
Yes/No
Page 6 of 14
EMPLOYMENT
30.Beginning with your present job and working backwards, list below all periods of employment for the past ten years or from age 18, whichever is less. Give dates of any unemployment between jobs in proper sequence. Include all part-time and full-time employment and anv military service. For any casino, horse racinq or qaminq related employment, please list your license number under “Title.” (If additional space is needed, attach a separate
sheet making certain to indicate the question number.) Have you been in the Military?
Yes E)No If yes, list regardless of time.
Name, Address and telephone Number
Title/Position Held and
Supervisor’s
Reason for leaving/
(Mo/Yr
of Employer(s)
Description of Duties
Name
Compensation at
Departure
31. Have you ever been discharged or asked to resign from a job?
Yes If Yes, complete below.
Employer’s Name & Address
Date of Discharge or
Reason for Leaving
Resignation
Page 7 of 14
CIVIL, CRIMINAL & INVESTIGATORY PROCEEDINGS
Prior to answering this question, carefully review the definitions and instructions which follow .
DEFINITIONS: For purposes of this question:
A.“Arrest” includes any time that you were stopped by any law enforcement officer and advised that you were under arrest, detained, held for questioning or were requested by a law enforcement officer to come to a law enforcement office or facility and answer questions. “Arrest” also includes any circumstances in which you were taken into custody by any law enforcement officer, fingerprinted, detained in any jail or detention center, or otherwise been the subject of a court order to appear in a judicial proceeding in which you were accused of a “crime or offense” as defined in subsection C.
B.“Charge” includes any indictment, complaint, information, summons, or other notice of the alleged commission of any “offense.”
C.“Offense” includes all felonies, misdemeanors, and summary offenses that may have required you to appear before any municipal, state, or federal grand jury, court, or any other judicial tribunal except juvenile court. “Offense” also includes all driving-related charges or offenses which carry any period of incarceration.
INSTRUCTIONS:
1.Answ er “YES” and provide all information to the best of your ability EVEN IF:
A.You did not commit the offense charged;
B.The charges were dismissed or downgraded to a lesser charge;
C.You completed a pretrial intervention or other rehabilitation or diversionary program;
D.You were not convicted;
E.You did not serve any time in a correctional facility;
F.The charges or offenses happened a long time ago; or
G.You were not arrested for the charge.
2.Answer “NO” if:
a)You have never been charged with or arrested for any crime or offense;
b)Your were arrested or charged when you were under eighteen (18) years of age and your arrest or charge, including any sentence that a court imposed, was adjudicated entirely in juvenile court;
c)The records of the charge or arrest have been expunged pursuant to an order of court or
otherwise sealed by a court of competent jurisdiction.
I I 1 have read and understand the definitions and instructions
IMPORTANT
Maryland tvi/Z make inquiries to establish w hether the identified individuals have had any involvement with law
enforcement agencies.
Failure to disclose anv such involvement w ill be taken into account in
assessing the Applicant’s character, honesty and integrity. Do you understand?: 1 1
32. Have you ever been arrested or charged w ith any offense in any jurisdiction?
1 1 YES
1 1 NO
If yes, complete the follow ing chart:
Disposition
Nature of Charge or
Date of Charge or
(Convicted,
Law Enforcement
Sentence
Offense/Location of Where
Acquitted,
Offense
Agency or Court
(if any)
Incident Occurred
Dismissed, Pending,
Involved
Pardoned, etc.)
VLTForm 2003 (Rev July 21,2011)
Page 8 of 14
33.To the best of your knowledge, has a criminal indictment, information or complaint ever been filed or returned against you, or named you as an unindicted party or unindicted co-conspirator in any criminal proceeding in any
jurisdiction?
'
Dyes Dno
Name and Address of Governmental
Nature of Proceeding
Outcome/Disposition
Date
Agency/Organization Involved
34.To the best of your knowledge, have you ever been the subject of an investigation conducted by any governmental agency/organization, court, commission, committee, grand jury or investigatory body (local, state, county, provincial, federal, national, etc.) other than in connection with a traffic summons?
YES ONO
Ifyes^complete the following chart:
Name and Address of Court or
Was
Date on which
Approximate Time Period of
Testimony
Other Agency
or Investigation
Investigation
Given?
was Given
35. Have you ever received a pardon, or has any government agency/organization dismissed, suspended or deferred any
criminal investigation or prosecution against you for any criminal offense?
О YES I I NO
If yes, complete the following chart:
Date of Pardon, Dismissal,
Type of Action Taken
Name and Address of Government Agency/Organization
Suspension or Deferral
Granting Pardon, Dismissal, Suspension or Deferral
36.Have you or any business entity with which you are or were associated, ever filed under bankruptcy, been petitioned into bankruptcy or made a proposal under any bankruptcy or insolvency law in any jurisdiction?
If yes, complete below:
Date Filed
Docket #
Name & Address of Court
Date Judgment
Entered.
Page 9 of 14
Misconceptions can often cloud the understanding of important processes, such as applying for a Maryland Lottery License. Here are five common misconceptions regarding the Maryland Lottery License form, along with clarifications to help dispel them.
Understanding these misconceptions can help streamline the application process and ensure that all applicants are better prepared. Clarity in these areas reduces the risk of mistakes and enhances the likelihood of a successful application.
Filling out the Maryland Lottery License form can be a straightforward process, but many applicants make common mistakes that can lead to delays or even denials. One frequent error is failing to read each question carefully. The form contains specific instructions, and overlooking a detail can result in an incomplete application. Applicants should take their time to ensure they understand what is being asked before providing their answers.
Another mistake often made is leaving blank spaces. The form explicitly states that every question must be answered. If a question does not apply, applicants should indicate "Does Not Apply." Neglecting to fill in all fields can raise red flags during the review process, potentially leading to rejection of the application. It's essential to provide a complete response to avoid unnecessary complications.
Many applicants also overlook the importance of accuracy in their statements. Misrepresenting information or failing to disclose material facts can have serious consequences. If the Maryland Lottery Commission finds discrepancies, it may deny the application or revoke a license that was granted based on false information. Honesty and transparency are crucial throughout the application process.
Finally, some individuals forget to sign the Statement and Authorization in the presence of a notary. This step is mandatory for the application to be valid. Without a proper signature, the application cannot be processed. Applicants should ensure that they complete this step to avoid unnecessary delays and ensure their application is submitted correctly.
When filling out and using the Maryland Lottery License form, there are several important points to keep in mind:
Understanding these key points can help streamline the application process and ensure compliance with Maryland's gaming regulations.
The Maryland Lottery License form is a critical document for individuals seeking employment in the gaming industry within Maryland. Alongside this form, several other documents are often required to ensure compliance with state regulations. Below is a list of additional forms and documents commonly associated with the Maryland Lottery License application process.
Each of these documents plays a vital role in the application process for a Maryland Lottery License. Ensuring that all required forms are completed accurately and submitted in a timely manner can significantly impact the success of obtaining the necessary gaming employee license.
The Maryland Lottery License form shares similarities with the Gaming Employee License Application, which is also a crucial document for individuals seeking employment in the gaming industry. Like the Maryland Lottery License, this application requires individuals to provide personal information and details about their employment history. Both forms necessitate a background check to ensure the applicant meets the qualifications set by the relevant regulatory authority. Moreover, they emphasize the importance of accuracy in the information provided, as any discrepancies could lead to denial or revocation of the license. This shared focus on thoroughness reflects the industry's commitment to maintaining integrity and safety within gaming environments.
Another document akin to the Maryland Lottery License is the Casino Employee License Application. This form serves a similar purpose by allowing individuals to apply for a license to work in a casino setting. Both applications require applicants to have a conditional offer of employment and outline specific duties that necessitate licensing. Additionally, they both require the submission of fingerprints and photographs, underscoring the importance of identity verification in the gaming industry. The need for a sponsoring employer to submit the application further aligns these two documents, ensuring that only qualified individuals gain access to sensitive areas of gaming facilities.
For those venturing into commercial real estate in Florida, understanding the terms documented in a Florida Commercial Lease Agreement form is critical. This legally binding document not only delineates the expectations between landlords and tenants but also safeguards their rights. Both parties must navigate this agreement with care, ensuring every obligation is clear and transparent. To further assist in grasping these complexities, you can find a comprehensive resource at https://floridadocuments.net/fillable-commercial-lease-agreement-form, which provides valuable insights and templates for successful transactions.
The Charitable Gaming License Application is yet another document that mirrors the Maryland Lottery License in its regulatory nature. This application is designed for organizations wishing to conduct charitable gaming events, such as bingo or raffles. Similar to the Maryland Lottery License, it requires detailed information about the organization, its members, and the intended gaming activities. Both forms also emphasize compliance with state regulations and the need for transparency in financial reporting. This parallel highlights the broader framework of oversight that governs gaming activities in Maryland, ensuring that all participants adhere to established standards.
The Occupational License Application for Gaming is comparable to the Maryland Lottery License, particularly in its focus on the qualifications of individuals working within the gaming sector. This application requires potential employees to disclose their work history and any relevant experience in gaming-related roles. Both documents also mandate a thorough review process by the licensing authority to assess the applicant's suitability for employment. The emphasis on character and integrity in both applications reflects the industry's commitment to fostering a responsible gaming environment.
Lastly, the Non-Gaming Employee License Application shares several characteristics with the Maryland Lottery License. This form is intended for individuals whose roles do not involve direct gaming activities but still require licensing due to their presence in a gaming facility. Both applications necessitate a sponsoring employer's involvement and require applicants to provide personal information and employment history. Furthermore, they both underscore the importance of a background check to ensure that all employees, regardless of their direct involvement in gaming, meet the necessary standards for working in such an environment. This comprehensive approach to licensing helps maintain the integrity of the gaming industry as a whole.