An application for an originator license must


(1) be in writing;


(2) be signed by the applicant and notarized;


(3) be on a form prescribed by the department;


(4) contain the name and residence address of the applicant;


(5) include a complete set of fingerprints of the applicant to obtain a report of criminal justice information and a national criminal history record check; and


(6) contain other information or supporting material that the department may require concerning the applicant, including other forms of identification of the applicant.