DMV USE ONLY

OCCUPATIONAL LICENSING NUMBER

A Public Service Agency

USED DEALER OR DEALER WHOLESALE ONLY

APPLICATION CHECKLIST
Instructions:
• Application forms may be completed online and printed or they can be printed and completed manually in ink.
• Each form must be submitted with an original signature.
• To be acceptable, they must be free from whiteout (fluid or tape). All information requested must be complete and accurate.
• Submit the above required forms and documents to a local Occupational Licensing Inspections Office. For office locations
refer to Occupational Licensing webpage at [Link].
Applicants applying for a used dealer or dealer-wholesale only license must attend a dealer education
program and pass a written examination administered by the Department of Motor Vehicles before submitting
the original Certificate of Completion with their application.

SECTION 1 — FEES REQUIRED

$175 Application Fee

Non-Refundable
$70 For Each Branch Location
$90 Each Dealer Plate (Auto) $92 (Motorcycle) Plus County Fees
County fees vary depending on the county where your business is located.
Dealer plates are optional.
$100 Autobroker Endorsement
Required only if adding autobroker endorsement to your retail license. (Not applicable for wholesale only license.)
$1 Family Support Program
$42 For Each Person Submitting ADM 1316 Fingerprint Card
Out-of-state applications only.
$16 Examination
Each retest will be an additional $16.

SECTION 2 — FORMS REQUIRED (Attach documents in the following order.)

Application for Original Occupational License, Part C (OL 12)

Original Application for Occupational License (OL 21A)

Surety Bond of Dealer (OL 25), OR Surety Bond of Motorcycle Dealer, Motorcycle Lessor-Retailer, All-Terrain
Vehicle Dealer, or Wholesale-Only Dealer [less than 25 vehicles per year] (OL 25B) OR Deposit Agreement
and Assignment (OL 25E) AND Payee Data Record (STD 204)
Authorization To Release Financial Information (OL 53)
Application for Occupational License Personal History Questionnaire (OL 29B)
Required for each person listed under ownership on form OL 12.
Appointment of Director as Agent for Service of Process (ADM 9050)
Required for each person listed under ownership on form OL 12.
Request for Live Scan Service [copy] (DMV 8016)
Required for each person completing form OL 29B.
Out-of-state residents call Occupational Licensing at (916) 229-3126 for Fingerprint Card (ADM 1316) and
Request for Exemption from Mandatory Electronic Fingerprint Submission Requirement (BCII 9004).
NOTE: Refer to Fingerprinting/Live Scan information on the Occupational Licensing webpage.

OL 248B (REV. 4/2020) WWW Print Clear Form

*11OL248B*
SECTION 3 — ADDITIONAL DOCUMENTS REQUIRED (Attach documents in the following order.)
Evidence of successful completion of the Vehicle Dealer Written Examination.
Applicants will take the written examination with their local Occupational Licensing Inspector.
A current California driver license or identification card is required.
The original Dealer Education Certificate of Completion issued by the public provider.
Certificate is valid for one year from course date.
If filing as a Corporation
• Most recent Statement of Information filed with the Secretary of State.
If filing as a Limited Liability Company or Limited Liability Partnership
• Most recent Statement of Information (Limited Liability Company) filed with the Secretary of State.
A copy of your Fictitious Name Statement.
Not required if your surname is included in your business name.
A copy of your State Board of Equalization Resale Permit.
Photograph(s) of business location.
NOTE: Refer to Photograph Procedure information on the Occupational Licensing webpage.

SECTION 4 — ADDITIONAL REQUIREMENTS ONCE LICENSED

Effective 7/1/2012 the seller must obtain a National Motor Vehicle Titling Information System (NMVTIS)
report for any used vehicle offered or displayed for sale, and must display a warning on the vehicle when
the report indicates the states have branded the title. Further information regarding NMVTIS or to locate a
vendor to access these reports is available at [Link]
SECTION 5 — IMPORTANT INFORMATION (Incomplete applications will be returned.)

Make and keep a copy of all documents for your records.

The department does not provide photocopies.
The department’s Business Partner Automation program offers alternatives for processing transactions
electronically. Information is available on the Occupational Licensing webpage.

Pursuant to California Vehicle Code (CVC) §11704 (b); upon receipt of an application for a license which is accompanied
by the appropriate fee, the department shall, within 120 days, make a thorough investigation of the information contained
in the application.

Print Clear Form

OL 248B (REV. 4/2020) WWW

 FIRM NUMBER

NAME
A Public Service Agency

APPLICATION FOR ORIGINAL OCCUPATIONAL LICENSE

(PART C)
A. OWNERSHIP INFORMATION:

List true full name, title of individual, and date of birth; each partner (designate whether general or limited); each principal Officer and
Director, or Stockholder of the corporation participating in the direction, control and management of the policy of the business; each
Member and Manager of the limited liability company participating in the direction, control and management of the policy of the business;
and each member of the association participating in the direction control and management of the association (attach separate sheet if
additional space is needed).
PRINT TRUE FULL NAME (Last, First, Middle) TITLE DATE OF BIRTH

B. CERTIFICATION:
INSTRUCTIONS: Complete Section 1, 2, 3, 4, or 5 below depending on whether ownership is an individual, partnership, corporation,
limited liability company, or association.
SECTION 1 – INDIVIDUAL
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 that I am the sole owner of (print firm name) ___________________________________________________________
and that all answers and information contained within Part A and Part B of this application are true and correct.
SIGNATURE TITLE DATE

X
SECTION 2 – PARTNERSHIP
We certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
We further certify that we are co-partners (print firm name) ____________________________________________________________
and that no other person is associated in the ownership of the business, and that all answers and information contained within Part A and
Part B of this application are true and correct.
SIGNATURE SIGNATURE SIGNATURE DATE

X X X
SECTION 3 – CORPORATION
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 that (print firm name) ______________________________________________________________________________
is incorporated in the State of_________________________________________ and our corporate number is _________________________
and is authorized by the State of California to transact business in California, and that all answers and information contained within Part
A and Part B of this application are true and correct.
SIGNATURE OF CORPORATE OFFICER AUTHORIZED TO SIGN FOR CORPORATION TITLE DATE

X
SECTION 4 – LIMITED LIABILITY COMPANY
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
I certify that (print firm name) __________________________________________________________________________________
is incorporated in the State of _______________________________and our LLC number is _________________________________,
and is authorized by the State of California to transact business in California, and that all answers and information contained within Part
A and Part B of this application are true and correct.
SIGNATURE OF MEMBER OR MANAGER AUTHORIZED TO SIGN FOR LLC TITLE DATE

X
SECTION 5 – ASSOCIATION
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 that (print firm name) _____________________________________________________________________________
is an association and that all answers and information contained within Part A and Part B of this application are true and correct.
SIGNATURE OF MEMBER AUTHORIZED TO SIGN FOR ASSOCIATION TITLE DATE

OL 12 (REV. 2/2007) WWW

Print Clear Form
*11OL012*
 DMV USE ONLY
FIRM NUMBER DATE APPLICATION RECEIVED

ACR NUMBER DATE PERMIT ISSUED

A Public Service Agency
ORIGINAL APPLICATION FEE DATE PERMIT EXPIRES

NVMB FEE REGION CC

ORIGINAL APPLICATION FOR FINGERPRINT FEE INSPECTOR NAME/ID NUMBER

OCCUPATIONAL LICENSE OTHER FEE TOTAL FEE

SUSPENSE RECEIPT NUMBER

SECTION 1 — BUSINESS INFORMATION

Dealer (Check one box.) Autobroker Endorsement Other Type of License (Check one box.)
Retail New (Retail License Only Dismantler Distributor
CVC §§165, 285(a), and 11700.2) OR
Retail Used Lessor-Retailer Manufacturer
Wholesale Yes No Transporter Remanufacturer

SECTION 2 — MAIN OFFICE (Complete OL 21 for Branch Locations.)

TRUE FULL NAME OF SOLE OWNER, ALL PARTNERS, CORPORATION, LIMITED LIABILITY COMPANY, OR ASSOCIATION

FIRM NAME TELEPHONE NUMBER

( )
FIRM ADDRESS

CITY STATE ZIP CODE

SECTION 3 — CHECK THE VEHICLES TO BE SOLD, MANUFACTURED OR DISTRIBUTED AT THIS LOCATION

Automobile/Commercial* Motorcycle* (including Off-Highway) All-Terrain Vehicle* Motorhome*

NEW Recreational Trailer* Trailer (Letter of Authorization required.) Snowmobile*
*OL 124 required.

Automobile/Commercial Motorcycle (including Off-Highway) All-Terrain Vehicle Motorhome

USED
Recreational Trailer Trailer Snowmobile

SECTION 4 — PLATE(S) REQUEST

Enter number of plates only. The Licensing Inspector will complete county fees and total.
Auto $90.00 + $_____ = $_____
71
x ______ = $______
0
MOTORCYCLE $92.00 + $______ = $______
73
x _____ = $______
0
Each Plate County Fees No. of Plates Total Each Plate County Fees No. of Plates Total

Auto also applies to trailers and motorhomes.

SECTION 5 — FOR DISMANTLER ONLY (Must also complete OL 21D.)

All plates acquired from vehicles will be:....................................................... Destroyed Turned into the department.
Initials
Pursuant to California Vehicle Code §11520(4), I agree to deliver to the department within 90 calendar days of
the date of vehicle acquisition, the last issued license plates or a certificate of license plate destruction (form
REG 42 serves as the certificate).
SECTION 6 — FOR MANUFACTURER OR REMANUFACTURER ONLY
Attach pictures and detailed description adequate to identify vehicle to be manufactured. List the 17-digit VIN number or
sample configuration from the Society of Automotive Engineers .

OL 21 A (REV. 3/2020) WWW Page 1 of 2

*11OL21A*
 FIRM NUMBER

NAME

SECTION 7 — FINANCIAL INSTITUTION BUSINESS ACCOUNT INFORMATION

NAME OF FINANCIAL INSTITUTION ACCOUNT NUMBER

ADDRESS OF FINANCIAL INSTITUTION CITY STATE ZIP CODE

NAME OF PERSON AUTHORIZED TO DRAW FUNDS OR ISSUE CHECKS FROM ACCOUNT TELEPHONE NUMBER

( )
IF ACCOUNT IS NOT CARRIED UNDER SAME NAME AS SHOWN ON THIS APPLICATION, UNDER WHAT NAME IS IT CARRIED?

SECTION 8 — PROPERTY USE APPROVAL

(Must be completed by applicant. Excludes out-of-state Manufacturers and Distributors.)
Does location meet all city and county property use requirements? ............................................................ Yes No
If yes, attach the appropriate property use form completed by an official of the agency responsible for this location.
SECTION 9 — PROPERTY DATA
Attach a copy of the lease or rental agreement or evidence of property ownership. If property is subleased, also include a
written authorization to sublease from the property owner.
PROPERTY IS: (Check one box.) APPROXIMATE SQUARE FEET
Leased Rented Owned Office Area Building Area Display Area Total Area
LEASE OR RENTAL PERIOD
0
PROPERTY OWNER FULL NAME TELEPHONE NUMBER

( )
PROPERTY OWNER ADDRESS CITY STATE ZIP CODE

SECTION 10 — APPLICANT CERTIFICATION

Initials
1. I have an established place of business where I agree to keep all books and records relating to the business,
available for, and open to inspection by any peace officer during regular business hours.
2. I understand that all Report of Sale or Notice of Acquisition Books and Special Plates issued to me by the Department
of Motor Vehicles are property of the State of California and must be surrendered to any authorized, identified
Department employee on demand.
3. The main place of business and all branches have offices and display or dismantling areas situated on the
same property where business related to the type of license issued is transacted. (Except Wholesale-Only and
Autobroker dealers.)
4. The place of business is properly identified by a sign posted in a conspicuous place in each and every location.
Such signs shall provide information relating to the business name and address so as to enable any person
doing business with me to properly identify the business. (Except Wholesale-Only dealers.)
5. I agree to notify the Department in writing immediately of any change in location of this business or any addition
or deletion of branch offices and to provide simultaneously a complete description of the new location of this
business and the name of the manager there.
6. I agree to notify the Department in writing immediately of any change in the ownership or in the legal structure
of this business and on request from the Department will submit new application papers properly reflecting the
changes together with the required fees.
7. I will maintain on file with the Department an authorization to sell each make of new vehicle that I sell and
report on new vehicle reports of sale.
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
PRINTED NAME OF SOLE OWNER, ALL PARTNERS, CORPORATE OFFICER, LLC MEMBER, OR ASSOCIATION REPRESENTATIVE TITLE

SIGNATURE OF SOLE OWNER, ALL PARTNERS, CORPORATE OFFICER, LLC MEMBER, OR ASSOCIATION REPRESENTATIVE DATE

X
PRINTED NAME OF INSPECTOR/NUMBER INSPECTOR SIGNATURE DATE

X
Page 2 of 2 OL 21 A (REV. 3/2020) WWW
Go to Page 1 Print Clear Form
 DMV USE ONLY
OCCUPATIONAL LICENSING NUMBER

A Public Service Agency

OCCUPATIONAL LICENSING SECTION

AUTHORIZATION TO RELEASE FINANCIAL INFORMATION

As an applicant for a dealer license with the Department of Motor Vehicles, I/we am/are required, pur-
suant to Section 11703.4 of the California Vehicle Code, to endorse an authorization for disclosure of
account(s) relating to the operation of the dealership.
TRUE FULL NAME OF SOLE OWNER, ALL PARTNERS, CORPORATION, LIMITED LIABILITY COMPANY, OR ASSOCIATION

FIRM NAME

I/we hereby authorize release of financial information concerning the dealership account(s) as fol-
lows: account number; name(s) of person(s) establishing account; date each account established; name
under which account(s) are held; name and address where statements are sent; name(s) of person(s)
authorized to withdraw funds from account(s); and, copies of signature card(s).

I hereby release, discharge, exonerate the , their

FINANCIAL INSTITUTION

agents and representatives and any person furnishing information from any and all liability of every nature
and kind arising out of the furnishing and inspection of such documents, records and other information,
and this release shall be binding on my legal representatives, heirs, and assignees.
This release will expire 120 days after the date signed.

A photocopy of this release is to be considered as valid as an original.

SIGNATURE SIGNATURE

X X
TITLE TITLE

DATE DATE

SIGNATURE SIGNATURE

X X
TITLE TITLE

DATE DATE

OL 53 (REV. 4/2013) WWW

Print Clear Form *11OL053*
 DMV USE ONLY
OCCUPATIONAL LICENSING NUMBER

A Public Service Agency

APPLICATION FOR OCCUPATIONAL LICENSE
PERSONAL HISTORY QUESTIONNAIRE
BUSINESS LICENSING UNIT

IMPORTANT — Read Carefully: Each person applying for an occupational license issued by the Department of Motor Vehicles
must complete this questionnaire. Before you submit this questionnaire with your application, be sure that you have signed it and
that you have fully answered each question. Incorrect information is grounds for refusal to issue a license.
SECTION 1 — APPLICANT INFORMATION (Type or print your true full name.)
NAME (LAST, FIRST, MIDDLE) DAYTIME TELEPHONE NUMBER

( )
RESIDENCE ADDRESS (NUMBER AND STREET) CITY STATE ZIP CODE EVENING TELEPHONE NUMBER

( )
DATE OF BIRTH SEX HAIR COLOR EYE COLOR HEIGHT WEIGHT

……
Male ……
Female ……
Nonbinary
DRIVER LICENSE/IDENTIFICATION CARD NUMBER STATE EXPIRATION DATE SOCIAL SECURITY / INDIVIDUAL TAXPAYER ID NUMBER

SECTION 2 — EMPLOYMENT HISTORY FOR THE PAST THREE YEARS (Begin with your most recent job. List each separately.)

FROM TO EMPLOYERS:
JOB TITLE/DUTIES PERFORMED
MO YR MO YR NAMES, ADDRESSES, TYPE OF BUSINESS

(ATTACH SEPARATE SHEET IF ADDITIONAL SPACE IS NEEDED)

SECTION 3 — EDUCATION (for Traffic Violator Schools Only)

NUMBER GRADUATED? DATE

NAME AND ADDRESS OF SCHOOL
OF YEARS YES OR NO COMPLETED

HIGH SCHOOL

COLLEGE OR
UNIVERSITY

OTHER

SECTION 4 — BACKGROUND INFORMATION

1. Have you ever been known by or used any name other than the name appearing on this questionnaire? ..... ……
Yes ……
NO
IF YES, LIST NAME(S)

2. Have you previously been or are you now licensed or have you ever applied in this state as a vehicle salesperson,
representative, distributor, dealer, registration service, dismantler, manufacturer, remanufacturer, transporter,
vehicle verifier, lessor-retailer, driving school owner, operator, or instructor, traffic violator school owner, operator
or instructor or all-terrain vehicle safety training organization or instructor? .................................................... ……
Yes ……
NO
IF YES, LIST LICENSE NUMBER

OL 29B (REV. 1/2019) WWW Print Clear Form

*11OL29B*
 DMV USE ONLY
OCCUPATIONAL LICENSING NUMBER

3. Have you ever had a business or occupational license issued by this department or an application for such
license refused, revoked, suspended or subjected to other disciplinary action or were you ever a partner,
managerial employee, officer, director, or stockholder in a firm licensed by this department, and the license
was revoked, suspended or subject to other disciplinary action? ............................................................... YES NO
IF YES, LIST LICENSE NUMBER, TYPE OF LICENSE, ACTION BY DEPARTMENT, AND DATE OF ACTION.

4. Were you ever the holder of an occupational license issued by another state, authorizing the same or similar
activities of a license, and that license was revoked or suspended for cause and was never reissued, or
was suspended for cause, and the terms of suspension have not been fulfilled? ....................................... YES NO
IF YES, DESCRIBE TYPE OF LICENSE, LIST LICENSE NUMBER, STATE LICENSE WAS ISSUED.

5. Have you ever had a civil judgment rendered against you, or as a sole owner, partner, managerial
employee, public administrator, officer, director, stockholder, or LLP/LLC managing member? .................. YES NO
If yes, was it a result of a state issued licensed activity? ............................................................................. YES NO
IF YES, STATE THE AMOUNT AND WHETHER PAID OR UNPAID

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

6. Have you as a sole owner, partner, managerial employee, officer, director, stockholder, or LLP/LLC
managing member sought relief from creditors due to financial hardship in either state or federal
court? ........................................................................................................................................................... YES NO
IF YES, DESCRIBE TYPE OF LICENSE, LIST LICENSE NUMBER, STATE LICENSE WAS ISSUED, GIVE DATE BANKRUPTCY FILED, NAME AND LOCATION OF
COURT OF JURISDICTION

7. Do you currently have any criminal charges pending against you in any jurisdiction? ................................ YES NO
IF YES, STATE THE COURT, CASE NUMBER AND THE NATURE OF THE CHARGES.

8. Have you ever: (If “YES”, give details below.)

(a) Been dismissed, fired, demoted, had your salary or compensation reduced or had any other
adverse action taken against you, for any reason? .................................................................................... YES NO
(b) Resigned from or quit a position while you were under investigation or after being informed
discipline would be taken against you, or during an appeal from a disciplinary action? ............................. YES NO
(c) Been rejected or told you would not receive permanent or continued employment during any
type of probationary or trial period on the job? ........................................................................................... YES NO
(d) If the termination, demotion or other adverse action from employment involved any civil or
administrative case, please state court or agency and case number. ........................................................ YES NO
DETAILS: (ATTACH SEPERATE SHEET IF ADDITIONAL SPACE IS NEEDED)

9. ALL APPLICANTS:
EXCLUDING TRAFFIC OFFENSES, have you ever been CONVICTED, PLACED ON PROBATION, OR
RELEASED FROM INCARCERATION FOLLOWING CONVICTION for any crime or offense, either Felony
or Misdemeanor, of ANY jurisdiction, within the last ten years? Read Important Notice on the next
page and complete Section 5. .................................................................................................................... YES NO
10. APPLICANTS FOR DRIVING SCHOOL OWNER, TRAFFIC VIOLATOR SCHOOL OWNER, ALL-TERRAIN
VEHICLE SAFETY TRAINING ORGANIZATION OWNER:
INCLUDING TRAFFIC OFFENSES, have you ever been CONVICTED, PLACED ON PROBATION, OR
RELEASED FROM INCARCERATION FOLLOWING CONVICTION for any crime or offense, either Felony
or Misdemeanor, of ANY jurisdiction, within the last ten years? Read Important
Notice on the next page and complete Section 5. ...................................................................................... YES NO

Print Clear Form

OL 29B (REV. 1/2019) WWW
 DMV USE ONLY
OCCUPATIONAL LICENSING NUMBER

IMPORTANT NOTICE IMPORTANT NOTICE IMPORTANT NOTICE

*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. If you
are awaiting judgment and sentencing following entry of a plea or jury verdict, you must still disclose the conviction. 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.

Failure to disclose all convictions, including those out-of-state or out-of-county 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.

Applicant Initials Required ___________

FAILURE TO INITIAL WILL DELAY PROCESSING OF THIS APPLICATION

SECTION 5 — CONVICTIONS

If you answered “Yes” to questions #9 or #10, list each separate offense, the date of conviction, offense, court of jurisdiction
and disposition in the appropriate columns.

TO EXPEDITE A REVIEW OF YOUR APPLICATION, THE FOLLOWING EVIDENCE MUST BE SUBMITTED:

• Certified copy of the arresting agency report;
• Certified copy of the court documents.
• CPC §1203.4, expungement of your conviction(s);*
• Written receipts for payment of court-ordered restitution, fines and fees;
• Character letters attesting to your honesty and integrity by persons who know the circumstances of your conviction(s);
• Evidence of completion of a drug or alcohol abuse program.
DISPOSITION OF OFFENSE
MISDEMEANOR (DESCRIBE SENTENCE)
DATE OF COURT OF JURISDICTION
CONVICTED OF OR
CONVICTION (FULL NAME AND ADDRESS) Amount Term of Jail or Date
FELONY
Fined Probation Prison Term Released

(ATTACH SEPARATE SHEET IF ADDITIONAL SPACE IS NEEDED)

FAILURE TO PROVIDE COMPLETE INFORMATION ON THIS APPLICATION, INCLUDING INFORMATION RELATING TO

EMPLOYMENT HISTORY AND CRIMINAL CONVICTIONS, IS GROUNDS TO DENY ISSUANCE OF A LICENSE BY THE
DEPARTMENT OF MOTOR VEHICLES.

SECTION 6 — 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.
SIGNATURE TITLE DATE

OL 29B (REV. 1/2019) WWW Print Clear Form

 DMV USE ONLY
OCCUPATIONAL LICENSING NUMBER

A Public Service Agency

APPLICATION FOR OCCUPATIONAL LICENSE
PERSONAL HISTORY QUESTIONNAIRE
BUSINESS LICENSING UNIT

IMPORTANT — Read Carefully: Each person applying for an occupational license issued by the Department of Motor Vehicles
must complete this questionnaire. Before you submit this questionnaire with your application, be sure that you have signed it and
that you have fully answered each question. Incorrect information is grounds for refusal to issue a license.
SECTION 1 — APPLICANT INFORMATION (Type or print your true full name.)
NAME (LAST, FIRST, MIDDLE) DAYTIME TELEPHONE NUMBER

( )
RESIDENCE ADDRESS (NUMBER AND STREET) CITY STATE ZIP CODE EVENING TELEPHONE NUMBER

( )
DATE OF BIRTH SEX HAIR COLOR EYE COLOR HEIGHT WEIGHT

……
Male ……
Female ……
Nonbinary
DRIVER LICENSE/IDENTIFICATION CARD NUMBER STATE EXPIRATION DATE SOCIAL SECURITY / INDIVIDUAL TAXPAYER ID NUMBER

SECTION 2 — EMPLOYMENT HISTORY FOR THE PAST THREE YEARS (Begin with your most recent job. List each separately.)

FROM TO EMPLOYERS:
JOB TITLE/DUTIES PERFORMED
MO YR MO YR NAMES, ADDRESSES, TYPE OF BUSINESS

(ATTACH SEPARATE SHEET IF ADDITIONAL SPACE IS NEEDED)

SECTION 3 — EDUCATION (for Traffic Violator Schools Only)

NUMBER GRADUATED? DATE

NAME AND ADDRESS OF SCHOOL
OF YEARS YES OR NO COMPLETED

HIGH SCHOOL

COLLEGE OR
UNIVERSITY

OTHER

SECTION 4 — BACKGROUND INFORMATION

1. Have you ever been known by or used any name other than the name appearing on this questionnaire? ..... ……
Yes ……
NO
IF YES, LIST NAME(S)

2. Have you previously been or are you now licensed or have you ever applied in this state as a vehicle salesperson,
representative, distributor, dealer, registration service, dismantler, manufacturer, remanufacturer, transporter,
vehicle verifier, lessor-retailer, driving school owner, operator, or instructor, traffic violator school owner, operator
or instructor or all-terrain vehicle safety training organization or instructor? .................................................... ……
Yes ……
NO
IF YES, LIST LICENSE NUMBER

OL 29B (REV. 1/2019) WWW Print Clear Form

*11OL29B*
 DMV USE ONLY
OCCUPATIONAL LICENSING NUMBER

3. Have you ever had a business or occupational license issued by this department or an application for such
license refused, revoked, suspended or subjected to other disciplinary action or were you ever a partner,
managerial employee, officer, director, or stockholder in a firm licensed by this department, and the license
was revoked, suspended or subject to other disciplinary action? ............................................................... YES NO
IF YES, LIST LICENSE NUMBER, TYPE OF LICENSE, ACTION BY DEPARTMENT, AND DATE OF ACTION.

4. Were you ever the holder of an occupational license issued by another state, authorizing the same or similar
activities of a license, and that license was revoked or suspended for cause and was never reissued, or
was suspended for cause, and the terms of suspension have not been fulfilled? ....................................... YES NO
IF YES, DESCRIBE TYPE OF LICENSE, LIST LICENSE NUMBER, STATE LICENSE WAS ISSUED.

5. Have you ever had a civil judgment rendered against you, or as a sole owner, partner, managerial
employee, public administrator, officer, director, stockholder, or LLP/LLC managing member? .................. YES NO
If yes, was it a result of a state issued licensed activity? ............................................................................. YES NO
IF YES, STATE THE AMOUNT AND WHETHER PAID OR UNPAID

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

6. Have you as a sole owner, partner, managerial employee, officer, director, stockholder, or LLP/LLC
managing member sought relief from creditors due to financial hardship in either state or federal
court? ........................................................................................................................................................... YES NO
IF YES, DESCRIBE TYPE OF LICENSE, LIST LICENSE NUMBER, STATE LICENSE WAS ISSUED, GIVE DATE BANKRUPTCY FILED, NAME AND LOCATION OF
COURT OF JURISDICTION

7. Do you currently have any criminal charges pending against you in any jurisdiction? ................................ YES NO
IF YES, STATE THE COURT, CASE NUMBER AND THE NATURE OF THE CHARGES.

8. Have you ever: (If “YES”, give details below.)

(a) Been dismissed, fired, demoted, had your salary or compensation reduced or had any other
adverse action taken against you, for any reason? .................................................................................... YES NO
(b) Resigned from or quit a position while you were under investigation or after being informed
discipline would be taken against you, or during an appeal from a disciplinary action? ............................. YES NO
(c) Been rejected or told you would not receive permanent or continued employment during any
type of probationary or trial period on the job? ........................................................................................... YES NO
(d) If the termination, demotion or other adverse action from employment involved any civil or
administrative case, please state court or agency and case number. ........................................................ YES NO
DETAILS: (ATTACH SEPERATE SHEET IF ADDITIONAL SPACE IS NEEDED)

9. ALL APPLICANTS:
EXCLUDING TRAFFIC OFFENSES, have you ever been CONVICTED, PLACED ON PROBATION, OR
RELEASED FROM INCARCERATION FOLLOWING CONVICTION for any crime or offense, either Felony
or Misdemeanor, of ANY jurisdiction, within the last ten years? Read Important Notice on the next
page and complete Section 5. .................................................................................................................... YES NO
10. APPLICANTS FOR DRIVING SCHOOL OWNER, TRAFFIC VIOLATOR SCHOOL OWNER, ALL-TERRAIN
VEHICLE SAFETY TRAINING ORGANIZATION OWNER:
INCLUDING TRAFFIC OFFENSES, have you ever been CONVICTED, PLACED ON PROBATION, OR
RELEASED FROM INCARCERATION FOLLOWING CONVICTION for any crime or offense, either Felony
or Misdemeanor, of ANY jurisdiction, within the last ten years? Read Important
Notice on the next page and complete Section 5. ...................................................................................... YES NO

Print Clear Form

OL 29B (REV. 1/2019) WWW
 DMV USE ONLY
OCCUPATIONAL LICENSING NUMBER

IMPORTANT NOTICE IMPORTANT NOTICE IMPORTANT NOTICE

*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. If you
are awaiting judgment and sentencing following entry of a plea or jury verdict, you must still disclose the conviction. 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.

Failure to disclose all convictions, including those out-of-state or out-of-county 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.

Applicant Initials Required ___________

FAILURE TO INITIAL WILL DELAY PROCESSING OF THIS APPLICATION

SECTION 5 — CONVICTIONS

If you answered “Yes” to questions #9 or #10, list each separate offense, the date of conviction, offense, court of jurisdiction
and disposition in the appropriate columns.

TO EXPEDITE A REVIEW OF YOUR APPLICATION, THE FOLLOWING EVIDENCE MUST BE SUBMITTED:

• Certified copy of the arresting agency report;
• Certified copy of the court documents.
• CPC §1203.4, expungement of your conviction(s);*
• Written receipts for payment of court-ordered restitution, fines and fees;
• Character letters attesting to your honesty and integrity by persons who know the circumstances of your conviction(s);
• Evidence of completion of a drug or alcohol abuse program.
DISPOSITION OF OFFENSE
MISDEMEANOR (DESCRIBE SENTENCE)
DATE OF COURT OF JURISDICTION
CONVICTED OF OR
CONVICTION (FULL NAME AND ADDRESS) Amount Term of Jail or Date
FELONY
Fined Probation Prison Term Released

(ATTACH SEPARATE SHEET IF ADDITIONAL SPACE IS NEEDED)

FAILURE TO PROVIDE COMPLETE INFORMATION ON THIS APPLICATION, INCLUDING INFORMATION RELATING TO

EMPLOYMENT HISTORY AND CRIMINAL CONVICTIONS, IS GROUNDS TO DENY ISSUANCE OF A LICENSE BY THE
DEPARTMENT OF MOTOR VEHICLES.

SECTION 6 — 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.
SIGNATURE TITLE DATE

OL 29B (REV. 1/2019) WWW Print Clear Form

 APPOINTMENT OF DIRECTOR AS AGENT DMV USE ONLY
O L NUMBER
FOR SERVICE OF PROCESS

KNOW ALL MEN BY THESE PRESENTS: That I/We

PRINCIPAL’S TRUE FULL NAME(S) AND DBA(S)

As Principal, who has applied for a license as a , hereby appoint(s) the Director of Motor Vehicles
TYPE LICENSE

as principal’s true and lawful agent upon whom all process may be served in any action, or actions which may hereafter be commenced against said
principal, arising out of any claim for damages suffered by any firm, person, association, organization, corporation or limited liability partnership, or
company, by reason of the violation by said principal of any of the terms and provisions of the California Vehicle Code or any condition of the bond.
Principal further stipulates and agrees that, when personal service of process upon principal cannot be made in this State after due diligence, that
service can be made upon the Director of Motor Vehicles. In the event of the Director’s absence from his/her office, that service can be made upon any
employee of the State of California in charge of the Director’s office, and that such service of process shall be of the same legal force and effect as if
served upon the principal personally.
The principal further stipulates and agrees that the agency created by said appointment shall continue for and during the period covered by any license
that may be issued by the Department of Motor Vehicles, and so long thereafter as the principal may be made to answer in damages for a violation of
the California Vehicle Code, or any condition of principal’s bond. The principal further agrees that for purposes of venue, whenever service is made
upon the Director, the service shall be deemed to have been made upon principal in the county in which principal has or last had his/her established
place of business.
IN WITNESS WHEREOF, the said principal has hereunto set his hand the
DATE

X
SIGNATURE OF PRINCIPAL

NOTARY CERTIFICATE OF ACKNOWLEDGEMENT Print Clear Form

A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document, to which this certificate
is attached, and not the truthfulness, accuracy or validity of that document.

State of California )

County of )

On before me, ,

personally appeared who proved to me on the basis

of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf
of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.

SIGNATURE OF NOTARY (SEAL)

OR DMV/CHP OFFICER ACKNOWLEDGEMENT OF SIGNATURE

On this day, , at this city, I witnessed the signature of

the Principal, who based on satisfactory identification, executed under authorized capacity their signature before me.
I certify under penalty of perjury under the laws of the State of California that the foregoing paragraph is true and correct.

DEPARTMENT OFFICIAL NAME & TITLE

*NOTE:
Officers and employees of the Department of Motor Vehicles (DMV) and the Department of the California Highway Patrol (CHP) are, for the purposes of
this code, authorized to administer oaths and acknowledge signatures, for which no fee shall be charged. CVC section 18
The instrument appointing the director as agent for the applicant for service of process shall be acknowledged by the applicant before a notary public.
CVC sections 11102(a)(5)(C), CVC 11202(a)(6)(C), 11403(d), 11710(d)
ADM 9050 (REV. 7/2015) WWW
A Public Service Agency REQUEST FOR LIVE SCAN SERVICE
Applicant Submission
(License, Certification, Permit Only, or Business Partner Automation Program Participant)

To verify your identity, please bring an official governmental photo document (e.g., driver license, identification
card, passport, etc.) with you to the live scan site. Processing fees are non-refundable.
1. CODE ASSIGNED BY DOJ
Please read instructions on reverse before completing form. ORI: A0059
APPLICANT COMPLETES (EXCEPT ITEM 15) — PLEASE PRINT.
2. CHECK APPROPRIATE BOX (SEE REVERSE FOR INSTRUCTIONS)
Ambulance Driver Certificate Only
A. Department of Motor Vehicles B. Department of Motor Vehicles
Licensing Operations Division Licensing Operations Division
Occupational Licensing Branch Issuance, Commercial Driver License
P. O. Box 932342 MS—L224 P.O. Box 942890
Sacramento, CA 94232-3420 Sacramento, CA 94232-3420
Five Digit Mail Code: 04620 Five Digit Mail Code: 04621
Contact: Operations Manager Contact: CDL/PDPS Manager
916-229-3153 916-657-5771
3. TYPE OF APPLICATION (ONLY IF CHECKING BOX “A” ABOVE) — Check One

License Certification Permit Business Partner Automation Program Participant (BPA)

Employer Testing Program Examiner (ETP)
4. APPLICANT NAME (LAST, FIRST, MIDDLE INITIAL)

5. AKA (LAST, FIRST)

ADDITIONAL AKA (LAST, FIRST)

6. DATE OF BIRTH 7. SEX 8. HEIGHT 9. WEIGHT 10. EYE COLOR 11. HAIR COLOR

Male Female Nonbinary

12. PLACE OF BIRTH 13. SOCIAL SECURITY NUMBER

14. CALIFORNIA DRIVER LICENSE/IDENTIFICATION NUMBER 15. NO BILLING NUMBER—APPLICANT PAYS 16. MISCELLANEOUS NUMBER

17. HOME ADDRESS AND TELEPHONE NUMBER STREET CITY STATE ZIP CODE TELEPHONE NUMBER

18. YOUR NUMBER (OCA NUMBER—AGENCY IDENTIFYING NUMBER) 19. IF RESUBMISSION, LIST ORIGINAL ATI NUMBER 20. LEVEL OF SERVICE
O L AD X DOJ FBI-BPA/ETP CHECK
LIVE SCAN OPERATOR COMPLETES
21. OPERATOR COMPLETING LIVE SCAN TRANSACTION 22. DATE

23. TRANSMITTING AGENCY (LSID NUMBER) 24. ATI NUMBER 25. AMOUNT COLLECTED 26. AMOUNT BILLED

DISTRIBUTION: ORIGINAL - Live Scan Operator

SECOND COPY - Requesting Agency
THIRD COPY - Applicant

Print Clear Form

DMV 8016 (REV. 1/2019) WWW