Fee: $10.00 + DOJ
Noncriminal Applicant
Fingerprint Fee
Receipt No. __________
STATE OF CALIFORNIA DEPARTMENT OF BUSINESS OVERSIGHT
320 West 4th Street, Suite 750
Los Angeles, California 90013-1105
(213) 576-7690
NOTICE OF OFFICERS, DIRECTORS, TRUSTEES, EMPLOYEES OR OTHER PERSONS DIRECTLY OR INDIRECTLY COMPENSATED BY ESCROW AGENTS
OFFICIAL USE ONLY
LAST NAME __________
Date submitted CII: __________
Applicant I.D. # __________
PLEASE PRINT OR TYPE
___________________________ | File No. ___________________________ | |
Name of Company |
ADDRESS OF MAIN OFFICE:
___________________________ | |||
Street | City | State | ZIP Code |
___________________________
EMPLOYING BRANCH OFFICE:
APPLICANT'S NAME: ______________________________Last______________________________First______________________________Middle
POSITION HELD OR TO BE HELD:
___________________________
HOME ADDRESS:
___________________________
___________________________ | |||
Street | City | State | ZIP Code |
DATE OF BIRTH: ____________________Month____________________Day__________Year PLACE OF BIRTH: ______________________________
___________________________
DRIVER'S LICENSE NUMBER:
HEIGHT: ____________________ WEIGHT: ____________________ SEX: ____________________ COLOR OF EYES: ____________________
COLOR OF HAIR: ____________________
* Fees should include the Department of Business Oversight's filing fee of ($10.00) and the fee charged by the Department of Justice (Section 11105, Penal Code) for processing Noncriminal Applicant Fingerprints.
Cal. Code Regs. Tit. 10, § 1726
2. Change without regulatory effect pursuant to section 100(b)(3), title 1, California Code of Regulations filed 12-15-89; operative 1-14-90 (Register 90, No. 1).
3. Change without regulatory effect amending subsection (b) filed 4-26-90 pursuant to section 100, title 1, California Code of Regulations. Printing delayed due to numerical error (Register 90, No. 41).
4. Change without regulatory effect amending subsections (b) and (c) filed 4-26-90 pursuant to section 100, title 1, California Code of Regulations (Register 90, No. 41).
5. Editorial correction of printing error in subsection (a), form in subsection (b), and HISTORY 4 (Register 91, No. 36).
6. Editorial correction of form in subsection (b) (Register 95, No. 12).
7. Change without regulatory effect amending form filed 5-24-99 pursuant to section 100, title 1, California Code of Regulations (Register 99, No. 22).
8. Amendment of section and NOTE filed 7-21-2003; operative 7-21-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 30).
9. Change without regulatory effect amending subsection (d) and amending NOTE filed 11-23-2005 pursuant to section 100, title 1, California Code of Regulations (Register 2005, No. 47).
10. Change without regulatory effect amending form within subsection (b) and subsection (d) filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
Note: Authority cited: Sections 17203.1 and 17400, Financial Code. Reference: Sections 17203.1, 17207, 17209, 17209.1 and 17312, Financial Code; and Section 11077.1, Penal Code.
2. Change without regulatory effect pursuant to section 100(b)(3), title 1, California Code of Regulations filed 12-15-89; operative 1-14-90 (Register 90, No. 1).
3. Change without regulatory effect amending subsection (b) filed 4-26-90 pursuant to section 100, title 1, California Code of Regulations. Printing delayed due to numerical error (Register 90, No. 41).
4. Change without regulatory effect amending subsections (b) and (c) filed 4-26-90 pursuant to section 100, title 1, California Code of Regulations (Register 90, No. 41).
5. Editorial correction of printing error in subsection (a), form in subsection (b), and HISTORY4 (Register 91, No. 36).
6. Editorial correction of form in subsection (b) (Register 95, No. 12).
7. Change without regulatory effect amending form filed 5-24-99 pursuant to section 100, title 1, California Code of Regulations (Register 99, No. 22).
8. Amendment of section and Note filed 7-21-2003; operative 7-21-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 30).
9. Change without regulatory effect amending subsection (d) and amending Note filed 11-23-2005 pursuant to section 100, title 1, California Code of Regulations (Register 2005, No. 47).
2. Change without regulatory effect pursuant to section 100(b)(3), title 1, California Code of Regulations filed 12-15-89; operative 1-14-90 (Register 90, No. 1).
3. Change without regulatory effect amending subsection (b) filed 4-26-90 pursuant to section 100, title 1, California Code of Regulations. Printing delayed due to numerical error (Register 90, No. 41).
4. Change without regulatory effect amending subsections (b) and (c) filed 4-26-90 pursuant to section 100, title 1, California Code of Regulations (Register 90, No. 41).
5. Editorial correction of printing error in subsection (a), form in subsection (b), and HISTORY 4 (Register 91, No. 36).
6. Editorial correction of form in subsection (b) (Register 95, No. 12).
7. Change without regulatory effect amending form filed 5-24-99 pursuant to section 100, title 1, California Code of Regulations (Register 99, No. 22).
8. Amendment of section and Note filed 7-21-2003; operative 7-21-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 30).
9. Change without regulatory effect amending subsection (d) and amending Note filed 11-23-2005 pursuant to section 100, title 1, California Code of Regulations (Register 2005, No. 47).
10. Change without regulatory effect amending form within subsection (b) and subsection (d) filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).
2. Change without regulatory effect pursuant to section 100(b)(3), title 1, California Code of Regulations filed 12-15-89; operative 1-14-90 (Register 90, No. 1).
3. Change without regulatory effect amending subsection (b) filed 4-26-90 pursuant to section 100, title 1, California Code of Regulations. Printing delayed due to numerical error (Register 90, No. 41).
4. Change without regulatory effect amending subsections (b) and (c) filed 4-26-90 pursuant to section 100, title 1, California Code of Regulations (Register 90, No. 41).
5. Editorial correction of printing error in subsection (a), form in subsection (b), and HISTORY 4 (Register 91, No. 36).
6. Editorial correction of form in subsection (b) (Register 95, No. 12).
7. Change without regulatory effect amending form filed 5-24-99 pursuant to section 100, title 1, California Code of Regulations (Register 99, No. 22).
8. Amendment of section and Note filed 7-21-2003; operative 7-21-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 30).
9. Change without regulatory effect amending subsection (d) and amending Note filed 11-23-2005 pursuant to section 100, title 1, California Code of Regulations (Register 2005, No. 47).
10. Change without regulatory effect amending form within subsection (b) and subsection (d) filed 8-13-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 33).