440 4862-2026

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4.9 out of 5

462 votes

The document is a criminal records request form from the Oregon Department of Consumer and Business Services (DCBS), Insurance Division. It outlines the process for applicants to provide personal information necessary for a criminal background check, which is required for licensing under specific Oregon statutes. The form includes sections for consent, personal details, previous names, social security number, and any criminal charges. It also contains fields for DCBS use regarding the outcome of the fitness determination.

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Click ‘Get Form’ to open the 440 4862 in the editor.
Begin by entering your personal information, including your Social Security number, date of birth, and driver's license number. Ensure accuracy as this information is crucial for the background check.
In the section regarding previous names, list all names you have used. This helps in verifying your background effectively.
Indicate if you have lived outside of Oregon for more than 60 consecutive days in the last three years. If yes, provide details about the locations and duration of stay.
List any criminal charges you have faced, including dates and jurisdictions. If necessary, attach a separate sheet for additional information.
Finally, sign and date the form at the bottom to consent to the release of your criminal background information.

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Versions	Form popularity	Fillable & printable
2009	4.9 Satisfied (462 Votes)

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