(c) The
Personal History Questionnaire shall contain the following information:
(1) The true full name of the
applicant.
(2) The residence address of the applicant.
(3)
The business and home telephone numbers of the applicant.
(4) The social security number of the
applicant.
(5) The physical description of the applicant including sex, color of hair, color of eyes,
height, weight and birthdate.
(6) Whether or not the applicant holds a valid California driver license.
When the applicant is a holder of a valid California driver license, the license number shall be provided.
(7) Any name or names the applicant has been known by or used other than the name provided in subdivision
(c)(1).
(8) The experience and employment record of the applicant for the past three years prior to the
date the personal history questionnaire is signed and dated by the applicant.
(9) For instructors only,
whether the applicant has attended and or completed high school or college, the name and address of any high school or college attended, and the date
studies were completed.
(10) Whether or not the applicant has previously been or is currently licensed in
California as a registration service; vehicle salesperson, representative, distributor, dealer, dismantler, manufacturer, remanufacturer,
transporter, 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. When the applicant has previously been or is currently licensed as described in
subdivision (c)(10), each current or previous occupational license number issued to the applicant shall be provided.
(11) Whether or not the applicant has ever had a business or occupational license issued by the department or an
application for such license refused, revoked, suspended, or subjected to other disciplinary action or was a partner, managerial employee, officer,
director, or stockholder in a firm licensed by the department, and the licence was revoked, suspended or subject to other disciplinary action. When
the applicant answers yes to subdivision (c)(11), the occupational license number, the type of license, the action and the date of the action taken
by the department shall be provided.
(12) Whether or not the applicant has ever had a civil judgment
rendered against him/her and whether or not the judgment was a result of activity of the applicant's firm licensed by the department. When the
applicant answers that the judgment was a result of activity of the applicant's firm licensed by the department, the amount of the judgment and
whether the judgment is paid or unpaid shall be provided.
(13) Whether the applicant was ever a partner,
managerial employee, officer, director, or stockholder in a firm that had a civil judgment rendered against it and whether or not the judgment was a
result of the activity of the firm licensed by the department. When the applicant indicates he/she was a partner, managerial employee, officer,
director, or stockholder in a firm that had a civil judgment rendered against it and the judgment was a result of the activity of the firm licensed
by the department, the amount of the judgment and whether the judgment is paid or unpaid shall be provided.
(14) Whether or not the applicant has ever declared bankruptcy or was a partner, managerial employee, officer,
director, or stockholder in a firm that declared bankruptcy. When the applicant indicates he/she has declared bankruptcy or was a partner, managerial
employee, officer, director, or stockholder in a firm that declared bankruptcy, the date the bankruptcy was filed and the name and location of the
court of jurisdiction shall be provided.
(15) Whether or not the applicant has ever been convicted,
placed on probation, or released from incarceration following conviction for any crime or offense, either felony or misdemeanor, including traffic
offenses, within the last ten years. When the applicant indicates he/she was convicted, placed on probation, or released from incarceration following
conviction for any crime or offense, either felony or misdemeanor, including traffic offenses, within the last ten years, each offense shall be
listed with the conviction date, the court of jurisdiction and the disposition.
(16) A statement signed
and dated by the applicant which certifies under the penalty of perjury all the answers and the information contained in the personal history
questionnaire are true and correct, and includes the city and state where the document was executed.
(17)
A statement signed by the owner, operator or administrator of the traffic violator school acknowledging the information provided on the personal
history questionnaire.