California Vehicle Salesperson License – Fill Out and Use This PDF

SECTION 1 — APPLYING FOR (Check one box.)

SECTION 2 — APPLICANT INFORMATION (Type or Print) USE YOUR TRUE FULL NAME

SECTION 3 — ADDITIONAL BACKGROUND INFORMATION

1.Have you previously been or are you now licensed or have you ever applied in this state as a vehicle salesperson, representative, distributor, dealer, dismantler, manufacturer, remanufacturer, transporter, verifier, lessor‑retailer,driving school owner, operator,

4.Have you as a sole owner, partner, managerial employee, officer, director, stockholder, or LLP/LLC managing member sought

IF YES, DESCRIBE TYPE OF LICENSE, LIST LICENSE NUMBER, STATE LICENSE WAS ISSUED, GIVE DATE BANKRUPTCY FILED, NAME AND LOCATION OF COURT OF JURISDICTION

DMV USE ONLY

OCCUPATIONAL LICENSING NUMBER

IMPORTANT NOTICE TO ALL APPLICANTS

TO EXPEDITE A REVIEW OF YOUR APPLICATION, YOU MAY SUBMIT A COPY OF THE ARRESTING AGENCY REPORT AND A CERTIFIED COPY OF THE COURT DOCUMENTS.

Even if you were pardoned, pled nolo contendere, or if the conviction was later expunged from the record of the court or set aside under California Penal Code (CPC ) §1203.4, or any other federal or state law equivalent, you must disclose the conviction for licensing purposes. If you are awaiting judgment and sentencing following entry of a plea or jury verdict, you must still disclose the conviction. Failure to disclose all convictions, including those out‑of‑state or out‑of‑country may result in the cancellation of the temporary permit and may result in the refusal of the occupational license. Listing all conviction information may not necessarily preclude you from receiving a license. Applicants need

NOT disclose a conviction for violation of California Health and Safety Code (CHSC) §§11357(b), (c), (d) and (e); or 11360(b), if the conviction is more than two years old.

Applicant Initials Required

FAILURE TO INITIAL WILL DELAY PROCESSING OF THIS APPLICATION

SECTION 4 — MISDEMEANOR OR FELONY CONVICTIONS

(ATTACH SEPARATE SHEET IF ADDITIONAL SPACE IS NEEDED)

SECTION 5 — APPLICANT CERTIFICATION

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

I further certify (or declare) under penalty of perjury under the laws of the State of California pursuant to CCR Title 13, Article 7, that I am a citizen of the United States, or I am eligible to apply for this benefit under the requirements of the Personal Responsibility and

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IT IS IMPORTANT THAT YOU READ AND UNDERSTAND

THE FOLLOWING INFORMATION.

ADVISORY STATEMENT

The information required on the attached form pertains to eligibility for issuance of an occupational license. It is required under authority of Division 5 of the California Vehicle Code (CVC). Failure to provide the information is cause for refusal to issue an occupational license.

This information is public record, regularly used by law enforcement agencies, and is open to inspection by the public. Information contained in these records, classified as confidential or personal pursuant to the Information Practices Act of 1977 and the Public Records Act, is exempt from disclosure. Individuals are entitled to inspect or obtain copies of information contained in their records during regular office hours by prior arrangement.

The Occupational Licensing Branch, P.O. Box 932342, Sacramento, CA 94232‑3420, is responsible for maintaining this information.

DISCLOSURE STATEMENT

SOCIAL SECURITY NUMBER COLLECTION DISCLOSURE —You are required by law to provide your social security number or your application will be denied.

“Your social security number will be collected pursuant to California Business and Professions Code (CBPC) §30. It is used in the administration of occupational licensing laws to determine eligibility for issuance or renewal of an occupational license subject to the applicable provisions of the CVC, CBPC §§29.5, 30 and 31, as well as California Welfare and Institutions Code (CWIC) §11350.6. It is also used to aid in the collection of monies owed in connection with failure to pay a fine or failure to appear in court by an applicant; and to aid in the collection of monies owed by an applicant in connection with Aid to Families with Dependent Children, Child Support and Establishment of paternity and Federal Payments for Foster Care and Adoption Assistance Programs, pursuant to 42 U.S.C. §§405 and 42 U.S.C. §651 et seq.

Your social security number is not provided for public inspection; however, it will be provided in response to requests for information from state and federal agencies operating and involved in the collection of taxes and child support payments pursuant to 42 U.S.C. 601 et seq., and CBPC §30.

Collection of your social security number is mandatory. Failure to furnish the information requested will result in denial of processing an application for issuance or renewal of an occupational license or permit, pursuant to CBPC §30, subdivision(c).”

DELINQUENT TAX DEBT

DELINQUENT TAX DEBT (Effective July 1, 2012) — California state law allows the California Department of Tax and Fee Administration and the Franchise Tax Board to share taxpayer information with the DMV and requires you to pay a delinquent state tax obligation. Failure to pay this delinquent tax obligation may result in the suspension of your Salesperson license.

Please be advised that you may not reapply for a license until a period of one year has elapsed since a previous license for which you are applying now has been revoked, refused, or denied pursuant to CVC §§11810(d) and 11107(c).

Applicant should retain this page for their information.

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