[§451K-11]  Application for licensure. 
(a)  Application for a license shall be made on an application form to be
furnished by the department.  An applicant shall provide the following
information:



(1)  The applicant's legal name;



(2)  The applicant's current residence and business
mailing addresses and phone numbers;



(3)  The applicant's social security number;



(4)  The date and place of any conviction of a penal
crime directly related to the profession or vocation in which the applicant is
applying for licensure, unless the conviction has been expunged or annulled, or
is otherwise precluded from consideration by section 831-3.1;



(5)  Proof that the applicant is a United States
citizen, a permanent resident, or is otherwise authorized to work in the United
States;



(6)  Disclosure of similar licensure in any state or
territory;



(7)  Disclosure of disciplinary action by any state or
territory against any license held by the applicant; and



(8)  Any other information the licensing authority may
require to investigate the applicant's qualifications for licensure.



(b)  Failure to provide the information
required by subsection (a) and pay the required fees shall be grounds to deny
the application for licensure. [L 2009, c 191, pt of §2]