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Use this form to provide personal history information for each individual who qualifies as an applicant for a 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out Section 1, which includes your personal information such as name, date of birth, gender, and contact details. Ensure all fields are completed accurately.
- If you have a Social Security Number (SSN), enter it in the designated field. If you do not have one, select the appropriate option provided.
- Indicate whether you consent to the use of your SSN for identity confirmation during a criminal records check by checking 'Yes' or 'No'.
- Answer questions regarding any felony convictions or unresolved arrests. If applicable, attach explanations as required.
- List any OLCC liquor or marijuana licenses you have applied for or held in the specified section.
- Finally, sign and date the form in Section 2 to affirm that your answers are true and correct.
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Related links
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May 14, 1992 the name, telephone number, title, electronic mail address, and facsimile number of each qualified individual for the plan holder; the list