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Employee Possessor Questionnaire (SOLO 2023)
"
*
" indicates required fields
COMPANY INFORMATION
What's an "Employee Possessor"? An "Employee Possessor" is someone who is required to handle regulated explosives (fireworks) as a requirement of their job. Not all jobs require someone to handle explosives.
1. Federal Explosives Licensee or Permittee Name
*
Pyro Shows, Inc., 115 N 1st Street, 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
Which office are you submitting to be an Employee Possessor (a.k.a. "a pyrotechnician")?
2. Federal Explosives License or Permit Number
*
1-TN-013-24-7C-12205 & 1-TN-013-20-7C-12206
1-AL-073-24-8E-00666 & 1-AL-073-20-8E-00665
5-TX-439-51-6K-01722
1-SC-091-50-7L-00269 & 1-SC-091-51-7L-00270
Select the option that matches your answer above. Ex: If you selected "Pyro Shows, Inc.", then select the "TN" license number.
YOUR INFORMATION
3. Name of Employee Possessor (your name)
*
Last
First
Middle
Include all three names when possible.
4. Aliases (Include given, married, maiden names)
If you have changed your name due to marriage or other life event, include your original birth name.
5. Position/Title
*
Technician
6. Social Security Number
This is optional, but will help prevent misidentification.
7. Date of Birth
*
Month
Day
Year
8. Place of Birth (City and State)
*
If you were not born in the United States, include the city/province and country of your birth.
9. Current Full Residential Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Please do not enter a PO Box number
10. Mailing Address (If different from residential address)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Please do not enter a PO Box number
11. Telephone Number (including area code)
*
12. Email Address
*
13. Driver's License or State ID Number (include State of issuance)
*
14. Previous Address(es)
Please provide residential history and dates for the past
five years
. If you have not moved addresses in the last five years, you can skip this question.
PHYSICAL DESCRIPTION
15. Sex
*
Female
Male
Non-Binary
16. Height
*
Feet
Inches
Enter "feet" and "inches" separately
17. Weight
*
Enter in lbs.
18. Eye Color
*
Black
Blue
Brown
Gray
Green
Hazel
Multiple
Pink
Other
If you wear
colored contacts
, use the color of your natural eyes. If you have
different colored eyes
, select the color used on your driver license.
19. Hair Color
*
Bald
Black
Blonde
Brown
Gray
Red
Sandy
White
Other
Select the dominant color of your hair as it appears most frequently.
20. Ethnicity - Hispanic or Latino?
*
Yes
No
21. Race (Please check one or more boxes.)
*
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
White
BACKGROUND
If answering "Yes" to any of the following questions, please provide details in the space provided.
NOTE:
If you currently work for multiple companies that have a Federal Explosives License in which
you are listed as an Employee Possessor
,
contact us
. You may need to manually fill out this form.
22. Have you ever been a Responsible Person or Employee Possessor for a Federal Explosives Licensee or Permittee? (If known, please include FEL/P Name and/or Number)
*
Yes, a Pyro Shows company
Yes, another company or business
No
NOTE:
If you are a
current Pyro Shows technician
who has filled out an EPQ in the past, then select
"Yes, a Pyro Shows company"
. If you currently work or have worked for another company with a FEL, choose
"Yes, another company or business"
. If you are not sure or you're a brand new technician, select
"No"
.
Select from below...
Pyro Shows, Inc.
Pyro Shows of Alabama
Pyro Shows of Texas
Pyro Shows East Coast
NOTE:
If you work for multiple Pyro Shows companies, just select the office you work for most of the time.
Please provide the name of the company or entity that you previously held status as an Employee Possessor or Responsible Person...
23. Will you be or are you an employee of the FEL/P listed question 1?
*
Yes
No
Pyro Shows considers technicians as employees, so the answer to this question is likely "Yes".
24. Will you have actual or constructive possession of explosive materials in the course of your employment? (See Definition 2)
*
Yes
No
The answer is likely "Yes", but read on for the definition...
Definition 2:
An Employee Possessor is an individual with actual or constructive possession of explosive materials during the course of his employment. Actual possession exists when a person is in immediate possession of explosive materials. Constructive possession exists when a person lacks direct physical control but has dominion over explosives materials through others. This is someone who has keys to storage locations, directs use of other employees or transports materials from one site to another.
25. Have you ever been denied permission to handle explosive materials by ATF?
*
Yes
No
Please provide full details below...
26. Have you ever been granted Explosives Relief from Disability? (If so, please attach a copy of the relief letter.)
*
Yes
No
You can attach a copy of the letter at the bottom of the form.
Please provide full details below...
27. Are you under indictment for information in any court for a felony or any other crime, for which the judge could imprison you for more than one year? // OR // Are you a current member of the military who has been charged with violation(s) of the Uniform Code of Military Justice, and whose charge(s) have been referred to a general court-martial?
*
Yes
No
Please provide full details below...
28. Have you ever been convicted in any court, including a military court, for a felony, or any other crime, for which the judge could have imprisoned you for more than one year, even if you received a shorter sentence, including probation?
*
Yes
No
Please provide full details below...
29. Are you a fugitive from justice?
*
Yes
No
30. Are you an unlawful user of or addicted to marijuana, any depressant, stimulant, narcotic drug, and/or any other controlled substance?
*
Yes
No
Warning:
The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes by state law.
31. Have you ever been adjudicated as a mental defective or committed to a mental institution?
*
Yes
No
32. Have you been discharged from the Armed Forces under dishonorable conditions?
*
Yes
No
Only dishonorable conditions apply.
Briefly explain the reasoning for your dishonorable discharge...
33. Country of Citizenship
*
United States of America
Other Country
If you are a citizen of multiple countries, then select "Other Country" and input the country names manually.
Name of Other Country (or Countries)
List all countries you are a legal citizen.
34. Have you ever renounced your United States citizenship?
*
Yes
No
35. Are you an alien who has been admitted to the United States for permanent residence?
*
Yes
No
36. Are you an alien who has been admitted to the United States under a nonimmigrant visa?
*
Yes
No
37. If you are an alien, record your U.S.-Issued Alien or Admission Number
SIGNATURE
38. Under the penalties imposed by 18 U.S.C. §§ 842 and 1001, I declare that I have examined any related documents submitted in regard to this questionnaire (ATF Form 5400.28), and to the best of my knowledge and belief, they are true, correct and complete. This signature, when presented by a duly authorized representative of the U.S. Department of Justice, will constitute consent and authority for the appropriate U.S. Department of Justice representative to examine and obtain copies and abstracts of records, and to receive statements and information regarding my background. Specifically, I hereby authorize the release of the following data or records to ATF: military information/records, medical information/ records, police and/or criminal records.
*
Signature Required
Please write your name as it appears above in your signature
*
Today's Date
*
Month
Day
Year
RENEWAL PERMISSION
This is optional but will save you time in the future.
NOTE: A copy of this form may be used for your renewal submission. I certify, under penalties of perjury, that my answers on this form are still true, accurate and complete.
Signature (For second submission)
Today's Date
Month
Day
Year
UPLOAD ITEMS
This is where you can upload any required supporting documents.
Upload any supporting documents needed to complete your submission
Max. file size: 64 MB.
Ex: Letter for Relief of Disability
Please provide additional information if you answered "Yes" to any of questions #29-37.
Include the question number followed by additional information as to why you answered "Yes" to any one of questions #29-37.
EX: 29 - I answered yes because...
Comments
This field is for validation purposes and should be left unchanged.
Δ
Employee Possessor Questionnaire (SOLO 2023)
"
*
" indicates required fields
COMPANY INFORMATION
What’s an “Employee Possessor”? An “Employee Possessor” is someone who is required to handle regulated explosives (fireworks) as a requirement of their job. Not all jobs require someone to handle explosives.
1. Federal Explosives Licensee or Permittee Name
*
Pyro Shows, Inc., 115 N 1st Street, 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
Which office are you submitting to be an Employee Possessor (a.k.a. “a pyrotechnician”)?
2. Federal Explosives License or Permit Number
*
1-TN-013-24-7C-12205 & 1-TN-013-20-7C-12206
1-AL-073-24-8E-00666 & 1-AL-073-20-8E-00665
5-TX-439-51-6K-01722
1-SC-091-50-7L-00269 & 1-SC-091-51-7L-00270
Select the option that matches your answer above. Ex: If you selected “Pyro Shows, Inc.”, then select the “TN” license number.
YOUR INFORMATION
3. Name of Employee Possessor (your name)
*
Last
First
Middle
Include all three names when possible.
4. Aliases (Include given, married, maiden names)
If you have changed your name due to marriage or other life event, include your original birth name.
5. Position/Title
*
Technician
6. Social Security Number
This is optional, but will help prevent misidentification.
7. Date of Birth
*
Month
Day
Year
8. Place of Birth (City and State)
*
If you were not born in the United States, include the city/province and country of your birth.
9. Current Full Residential Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Please do not enter a PO Box number
10. Mailing Address (If different from residential address)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Please do not enter a PO Box number
11. Telephone Number (including area code)
*
12. Email Address
*
13. Driver's License or State ID Number (include State of issuance)
*
14. Previous Address(es)
Please provide residential history and dates for the past
five years
. If you have not moved addresses in the last five years, you can skip this question.
PHYSICAL DESCRIPTION
15. Sex
*
Female
Male
Non-Binary
16. Height
*
Feet
Inches
Enter “feet” and “inches” separately
17. Weight
*
Enter in lbs.
18. Eye Color
*
Black
Blue
Brown
Gray
Green
Hazel
Multiple
Pink
Other
If you wear
colored contacts
, use the color of your natural eyes. If you have
different colored eyes
, select the color used on your driver license.
19. Hair Color
*
Bald
Black
Blonde
Brown
Gray
Red
Sandy
White
Other
Select the dominant color of your hair as it appears most frequently.
20. Ethnicity – Hispanic or Latino?
*
Yes
No
21. Race (Please check one or more boxes.)
*
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
White
BACKGROUND
If answering “Yes” to any of the following questions, please provide details in the space provided.
NOTE:
If you currently work for multiple companies that have a Federal Explosives License in which
you are listed as an Employee Possessor
,
contact us
. You may need to manually fill out this form.
22. Have you ever been a Responsible Person or Employee Possessor for a Federal Explosives Licensee or Permittee? (If known, please include FEL/P Name and/or Number)
*
Yes, a Pyro Shows company
Yes, another company or business
No
NOTE:
If you are a
current Pyro Shows technician
who has filled out an EPQ in the past, then select
“Yes, a Pyro Shows company”
. If you currently work or have worked for another company with a FEL, choose
“Yes, another company or business”
. If you are not sure or you’re a brand new technician, select
“No”
.
Select from below…
Pyro Shows, Inc.
Pyro Shows of Alabama
Pyro Shows of Texas
Pyro Shows East Coast
NOTE:
If you work for multiple Pyro Shows companies, just select the office you work for most of the time.
Please provide the name of the company or entity that you previously held status as an Employee Possessor or Responsible Person…
23. Will you be or are you an employee of the FEL/P listed question 1?
*
Yes
No
Pyro Shows considers technicians as employees, so the answer to this question is likely “Yes”.
24. Will you have actual or constructive possession of explosive materials in the course of your employment? (See Definition 2)
*
Yes
No
The answer is likely “Yes”, but read on for the definition…
Definition 2:
An Employee Possessor is an individual with actual or constructive possession of explosive materials during the course of his employment. Actual possession exists when a person is in immediate possession of explosive materials. Constructive possession exists when a person lacks direct physical control but has dominion over explosives materials through others. This is someone who has keys to storage locations, directs use of other employees or transports materials from one site to another.
25. Have you ever been denied permission to handle explosive materials by ATF?
*
Yes
No
Please provide full details below…
26. Have you ever been granted Explosives Relief from Disability? (If so, please attach a copy of the relief letter.)
*
Yes
No
You can attach a copy of the letter at the bottom of the form.
Please provide full details below…
27. Are you under indictment for information in any court for a felony or any other crime, for which the judge could imprison you for more than one year? // OR // Are you a current member of the military who has been charged with violation(s) of the Uniform Code of Military Justice, and whose charge(s) have been referred to a general court-martial?
*
Yes
No
Please provide full details below…
28. Have you ever been convicted in any court, including a military court, for a felony, or any other crime, for which the judge could have imprisoned you for more than one year, even if you received a shorter sentence, including probation?
*
Yes
No
Please provide full details below…
29. Are you a fugitive from justice?
*
Yes
No
30. Are you an unlawful user of or addicted to marijuana, any depressant, stimulant, narcotic drug, and/or any other controlled substance?
*
Yes
No
Warning:
The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes by state law.
31. Have you ever been adjudicated as a mental defective or committed to a mental institution?
*
Yes
No
32. Have you been discharged from the Armed Forces under dishonorable conditions?
*
Yes
No
Only dishonorable conditions apply.
Briefly explain the reasoning for your dishonorable discharge…
33. Country of Citizenship
*
United States of America
Other Country
If you are a citizen of multiple countries, then select “Other Country” and input the country names manually.
Name of Other Country (or Countries)
List all countries you are a legal citizen.
34. Have you ever renounced your United States citizenship?
*
Yes
No
35. Are you an alien who has been admitted to the United States for permanent residence?
*
Yes
No
36. Are you an alien who has been admitted to the United States under a nonimmigrant visa?
*
Yes
No
37. If you are an alien, record your U.S.-Issued Alien or Admission Number
SIGNATURE
38. Under the penalties imposed by 18 U.S.C. §§ 842 and 1001, I declare that I have examined any related documents submitted in regard to this questionnaire (ATF Form 5400.28), and to the best of my knowledge and belief, they are true, correct and complete. This signature, when presented by a duly authorized representative of the U.S. Department of Justice, will constitute consent and authority for the appropriate U.S. Department of Justice representative to examine and obtain copies and abstracts of records, and to receive statements and information regarding my background. Specifically, I hereby authorize the release of the following data or records to ATF: military information/records, medical information/ records, police and/or criminal records.
*
Signature Required
Please write your name as it appears above in your signature
*
Today's Date
*
Month
Day
Year
RENEWAL PERMISSION
This is optional but will save you time in the future.
NOTE: A copy of this form may be used for your renewal submission. I certify, under penalties of perjury, that my answers on this form are still true, accurate and complete.
Signature (For second submission)
Today's Date
Month
Day
Year
UPLOAD ITEMS
This is where you can upload any required supporting documents.
Upload any supporting documents needed to complete your submission
Max. file size: 64 MB.
Ex: Letter for Relief of Disability
Please provide additional information if you answered "Yes" to any of questions #29-37.
Include the question number followed by additional information as to why you answered “Yes” to any one of questions #29-37.
EX: 29 – I answered yes because…
Comments
This field is for validation purposes and should be left unchanged.
Δ