EPQ Form

"*" indicates required fields

URL

This field is for validation purposes and should be left unchanged.

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*

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*

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*

Select the dominant color of your hair as it appears most frequently.

20. Ethnicity - Hispanic or Latino?*

Yes

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

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

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

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

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

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

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

Please provide full details below...

29. Are you a fugitive from justice?*

Yes

30. Are you an unlawful user of or addicted to marijuana, any depressant, stimulant, narcotic drug, and/or any other controlled substance?*

Yes

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

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

Yes

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

35. Are you an alien who has been admitted to the United States for permanent residence?*

Yes

36. Are you an alien who has been admitted to the United States under a nonimmigrant visa?*

Yes

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*

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

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...

EPQ Form

COMPANY INFORMATION

YOUR INFORMATION

PHYSICAL DESCRIPTION

BACKGROUND

SIGNATURE

RENEWAL PERMISSION

UPLOAD ITEMS

MAKING SPARKS ACROSS THE U.S.A

TENNESSEE

ALABAMA

TEXAS

SOUTH CAROLINA