Employee Possessor Questionnaire (SOLO)

Your Information

Name*

First Middle Last

Social Security Number

This is optional, but will help prevent misidentification.

Place of Birth (City and State)*

Date of Birth*

Race/Ethnicity*

American Indian
Asian
Black/African American
Hispanic
Pacific Islander/Native Hawaiian
White

Check one or more boxes that apply.

Sex*

Female
Male

Home/Cell Phone (include area code)*

Physical Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Please do not enter a PO Box number

Explosives Applicant Business Name

Name and address of explosives business or operations at which you are an employee possessor*

Pyro Shows, Inc. PO Box 1776 La Follette, TN 37766
Pyro Shows of Alabama, 3325 Poplar Lane, Adamsville, AL 35005
Pyro Shows of Texas, 6601 Nine Mile Azle Road, Fort Worth, TX 76135
Pyro Shows East Coast, Inc. 4652 Catawba River Road, Catawba, SC 29704

Need Help? If you are not sure, pick "Pyro Shows, Inc." (the first option).

Your position in the explosives business*

Technician

Federal explosives license/permit number*

1-TN-013-24-4C-12205 & 1-TN-013-20-4C-12206
1-AL-073-24-5E-00666 & 1-AL-073-20-5E-00665
5-TX-439-51-6K-01722
1-SC-091-50-PA-00269 & 1-SC-091-51-PA-00270

Need Help? Pick the "TN" license number if you selected "Pyro Shows, Inc.". Pick the "AL" license number is you selected "Pyro Shows of Alabama", etc.

Are you a citizen of the United States?*

Yes
No

We apologize, but we are currently unable to accept the EPQ through our website unless you are a United States citizen. We would still love to have you join the team, so fill out the original form and email the PDF to keysa@pyroshows.com. The original EPQ form can be downloaded here - ATF EPQ Form

Background & Previous History

Are you a fugitive from justice?*

Yes
No

Are you an unlawful user of narcotics, marijuana, cocaine, or any controlled substance?*

Yes
No

Have you ever been convicted in a court of a felony or any other crime which a judge could have imprisoned you for more than one year?*

Yes
No

Are you under indictment for information in any court for a felony, or any crime, for which the judge could imprison you for more than one year?*

Yes
No

Have you ever been adjudicated mentally defective (which includes having been adjudicated incompetent to manage your own affairs) or have you ever been committed to a mental institution?*

Yes
No

Have you ever been discharged from the Armed Forces under dishonorable conditions?*

Yes
No

Have you ever renounced your United States citizenship?*

Yes
No

Are you an alien in the United States?*

No

Signature & Authorization of Understanding

Today's Date*

Under the penalties imposed by Federal law, I certify under the penalty of perjury that the answers on this questionnaire are true, accurate and complete*

Type your full name in the box above.

We will automatically use a copy of this form for your renewal submissions unless you opt out below.

Please do not submit this form for any renewal submissions. I prefer to fill out the form again.

Your Signature*

I certify under the penalty of perjury that my answers on this form are true and accurate.

Pyro Shows