Transfer/Promotion Clearance Form

If applying for Transfer/Promotion please select and option below and fill out the top section of this form. If applying for a License Request Update, please select an option below and fill out the lower section of this form.

Form Usage:

Transfer/Promotion License Request Update

First Name

Middle Name

Last Name

Social Security Number

Gaming License

Date of Hire

Proposed Transfer/Promotion From

From

Current Position

Note

Current Department

Proposed Transfer/Promotion To

New Position

Note

New Department

Proposed Effective Date

Summary of New Services Performed

License Request Update

License Information

Name to appear on license

Facility

Title

Security Level

Please note when issuing security clearance that access levels are not to be taken lightly or issued frivolously.

Reason for Update/Request

Name change

Scan verification if change is non-grammatical (i.e. Marriage Cert, Divorice Papers, etc)

Title change Damaged Department change Lost

($15 charge)

Other

All changes will be 1/2 cost of initial license fee unless otherwise noted.

Additional Comments

TGC USE ONLY

Approved:

Denied

(Due to background check)

Gaming Commission Administrator
Date