The Maryland Lottery License form is a crucial document required for individuals seeking employment as video lottery gaming employees in Maryland. This application must be completed by those who have received a conditional job offer from a licensed facility operator or manufacturer, and it outlines the responsibilities and qualifications necessary for obtaining a gaming employee license. To ensure a smooth application process, make sure to fill out the form accurately and completely by clicking the button below.
The Maryland Lottery License form is a crucial document for individuals seeking employment within the state's 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 to obtain a Video Lottery Gaming Employee License. Applicants must be engaged in activities such as operating video lottery terminals, maintaining financial records, or conducting security measures within gaming facilities. The form mandates that applicants provide accurate information and complete every section, as any omissions or inaccuracies could lead to denial of the application. Notably, the application process also requires a photograph and fingerprints to ensure thorough background checks. Additionally, it highlights the fees associated with the application, including non-refundable charges for processing and licensing. Understanding the form’s requirements and adhering to its guidelines is essential for a successful application, as the burden of proof lies with the applicant to demonstrate their qualifications for this privilege.
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
Once you have the Maryland Lottery License form, you can begin filling it out. This process involves providing accurate information about yourself and your employment situation. After completing the form, it will be submitted by your sponsoring licensee to the Maryland State Lottery Commission.
The Maryland Lottery License form is an application used by individuals seeking a Video Lottery Gaming Employee License. This license is required for those who will be working in various roles related to the operation of video lottery terminals and associated equipment within licensed facilities in Maryland.
Individuals who have received a conditional job offer from a licensed facility operator, manufacturer, or contractor must complete this application. The roles that require this license include, but are not limited to, booth operators, slot machine mechanics, security personnel, and auditing employees. If your job duties do not involve these tasks, you may need a non-gaming license instead.
The sponsoring licensee, which holds a Maryland Video Lottery Manufacturer, Operator, or Contractor Gaming License, is responsible for ensuring the application is completed correctly. They must submit the form to the Maryland State Lottery Commission on behalf of the applicant employee. Additionally, they need to complete the Certification of Sponsored Licensee section at the end of the application.
The applicant employee must fill out the form accurately and submit it to the sponsoring licensee. It is crucial to provide complete answers to all questions, as any omissions or misrepresentations can lead to denial of the application. If a question does not apply, the applicant should indicate “Does Not Apply.”
Yes, there are several fees that must be paid at the time of application submission. These include:
Note that these fees are non-refundable and must be paid via certified/bank check or money order.
If the application is denied, the applicant will not receive a license, and the sponsored gaming employee license will be subject to revocation and suspension proceedings. It's essential to maintain honesty and transparency throughout the application process to avoid such consequences.
Along with the completed application form, the applicant must provide a recent photograph and submit fingerprints. These elements are necessary for the background investigation conducted by the Maryland State Lottery Commission.
The initial term of the Video Lottery Gaming Employee License is three years. Renewal is also available for another three-year term, but a renewal fee of $150.00 applies.
After submitting the application, it is important to keep a copy for your records. The application and all related materials become the property of the Maryland State Lottery Commission and will not be returned. Additionally, ensure that the Statement and Authorization section is signed in the presence of a notary.
Failing to read the instructions thoroughly. Many applicants overlook specific requirements outlined in the form, leading to incomplete submissions.
Leaving blank spaces in the application. Every question must be answered. If a question does not apply, applicants should indicate “Does Not Apply” instead of leaving it blank.
Not providing accurate information. Misrepresentations or omissions can result in application denial.
Submitting the application directly rather than through the sponsoring licensee. The form must be submitted by the sponsored licensee, not the applicant.
Neglecting to sign the Statement and Authorization in the presence of a notary. This step is crucial for the application to be valid.
Modifying pre-printed questions or information on the form. Any changes made can lead to denial of the application.
Failing to include required attachments. If additional space is needed to answer a question, applicants should provide this information on a separate page and clearly identify the corresponding question.
The Maryland Lottery License form is a crucial document for individuals seeking employment in the gaming industry within the state. However, several additional forms and documents are often required to complete the licensing process. Each of these documents serves a specific purpose in ensuring compliance with state regulations and maintaining the integrity of the gaming environment.
Understanding these forms and documents is essential for anyone navigating the Maryland gaming licensing process. Each document plays a vital role in ensuring that applicants meet the necessary legal requirements and uphold the standards set forth by the Maryland State Lottery Commission.
The Maryland Lottery License form shares similarities with the Alcoholic Beverage License application. Both documents require individuals to disclose personal information, including employment history and any criminal background. Each application serves as a means to ensure that individuals involved in regulated industries meet specific standards and qualifications. The process for both licenses includes a review of the applicant's background, and any false information can lead to denial or revocation of the license.
Another comparable document is the Gaming Employee License application used in various states. Like the Maryland Lottery License, this application is designed for individuals who will be working in gaming facilities. Applicants must provide detailed information about their roles and responsibilities, similar to the requirements outlined in the Maryland form. Both documents emphasize the importance of accuracy in the information provided, as misrepresentation can lead to severe consequences, including denial of the application.
The Professional License application, often required for fields such as healthcare or law, is also similar. Both the Maryland Lottery License and professional licenses necessitate a thorough vetting process to ensure that applicants are qualified to operate within their respective industries. Each application typically requires documentation of education, experience, and sometimes a background check, reinforcing the need for integrity and accountability in professional roles.
The Contractor License application mirrors the Maryland Lottery License in its focus on ensuring compliance with state regulations. Applicants for contractor licenses must provide detailed information about their qualifications and work history, much like the requirements for gaming employees. Both applications also require a fee and may involve a review process that assesses the applicant's ability to adhere to industry standards and regulations.
Additionally, the Business License application has parallels with the Maryland Lottery License form. Both documents require the applicant to provide information about their business operations and ownership structure. This ensures that all parties involved in the business are vetted and meet the necessary criteria to operate legally. The review process for both licenses is aimed at protecting the public and maintaining industry integrity.
The Employment License application for certain professions, such as teaching or nursing, is another document that shares similarities. Both the Maryland Lottery License and employment licenses require background checks and verification of qualifications. Each application aims to ensure that individuals in these roles are fit to perform their duties and uphold the standards of their respective fields.
Lastly, the Permit application for special events, such as fairs or festivals, is akin to the Maryland Lottery License. Both require detailed information about the event or activity, including the roles of individuals involved. Each application serves to ensure that all participants comply with relevant laws and regulations, safeguarding the interests of the public and maintaining order during events.
When filling out the Maryland Lottery License form, it is essential to follow specific guidelines to ensure a smooth application process. Below is a list of things you should and shouldn't do.
Understanding the Maryland Lottery License form can be challenging, and several misconceptions often arise. Here are nine common misunderstandings about the application process:
Being aware of these misconceptions can help applicants navigate the Maryland Lottery License process more effectively. It is essential to understand the requirements and responsibilities involved to ensure a smooth application experience.
When filling out the Maryland Lottery License form, it's essential to understand the process and requirements. Here are some key takeaways to keep in mind:
By keeping these points in mind, applicants can navigate the Maryland Lottery License process more smoothly and increase their chances of approval.