Statement of Identity and Employment Application DBO-EL 17419 DBOEL 17419 (Rev 5-17) 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your exact full name in the designated fields. Ensure you provide your first, middle, and last names without using initials or nicknames.
  3. Fill out your employment history for the last ten years. Include the dates of employment, employer name and address, as well as your occupation and duties. If more space is needed, attach a separate schedule.
  4. Provide your residence addresses for the past ten years in a similar format as your employment history. Again, attach additional pages if necessary.
  5. Answer the questions regarding any legal issues or previous licenses. If applicable, provide details and attach certified copies of relevant documents.
  6. Complete the verification section at the end of the form by signing and dating it to confirm that all information provided is true.

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