Confidential Resume Submitted To The Commissioner Of Business Oversight
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3– DEPARTMENT OF BUSINESS OVERSIGHT
STATE OF CALIFORNIA
CONFIDENTIAL RESUME SUBMITTED TO THE COMMISSIONER OF BUSINESS
OVERSIGHT, STATE OF CALIFORNIA
DBO-3 (Rev. 5-16)
If space provided is not sufficient, insert supplemental page with appropriate references thereto.)
1.
Full Name ______________________________________________________________________________________________________
Have you ever used (or been known under) any other name or names? ________________________________________________
California Driver's License Number _______________________________________________________________________________
2.
3.
Residence address _______________________________________________________________________________________________
(If you have lived at this address for less than ten years, please list former residence addresses and dates occupied for the past ten years. )
Business phone _____________________________________
4.
Business address
Place of birth _______________________________________________________
5.
Date of birth
6.
Years resident of community
Marital status _______________________________________________________
7. What is your present occupation or business affiliation: (in detail) ____________________________________________________
________________________________________________________________________________________________________________
8. What were your former occupations or business affiliations? (in detail) _______________________________________________
________________________________________________________________________________________________________________
9.
Have you ever been arrested for other than minor traffic violations?
(If the answer to question 9 is
affirmative, please attach a statement giving the full details including final disposition of each case.)
10. Has any corporation in which you have been a director, officer, or substantial stockholder, or has any other form of
business organization (including, but not limited to, partnerships, joint ventures and sole proprietorships) with which
you have been associated or employed in any management capacity, ever been subject to criminal prosecution?
(If so, please attach a statement giving the full details and final disposition thereof.)
11. Have you, or has any corporation in which you have been a director, officer or substantial stockholder, or has any other
form of business organization (including, but not limited to, partnerships, joint ventures and sole proprietorships) with
which you have been associated or employed in any management capacity ever been:
(a) licensed to engage in any business or profession by any government agency? ____________________________________
(b) refused a license to engage in any business or profession by any government agency, or has any such license
ever been suspended or revoked?
____________________________________________________________________________________________________________
(c) bankrupt, forced into liquidation, placed in receivership, or subject to similar proceedings? _________________________
(d)
named in any order, judgment or decree of any court, government agency or administrator, temporarily or
permanently restrained or enjoined from engaging in or continuing any conduct, practice or employment?
___________________________________________________________________________________________________________
(e)
refused a bond or had a bond revoked or canceled? _ ___________________________________________________________ _
(If the answer to any part of question 11 is affirmative, please attach a statement giving the full details.)
12. Are you, or is any corporation in which you have been a director, officer or substantial stockholder, or is any other
form of business organization (including, but not limited to, partnerships, joint ventures and sole proprietorships) with
which you have been associated or employed in any management capacity, a party to any civil action now pending?
(If so, attach statement giving full details.)
The above information is certified to be complete and correct to the best of my knowledge.
Dated:
, 20
Signature:
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