The Form A filing must disclose background information on the applicant or persons associated with the applicant through a biographical affidavit that includes a third party background check by a vendor approved by the director. The information must include the following for individual applicants or persons who are directors, executive officers, or owners of ten percent or more of the voting securities of the applicant if the applicant is not an individual:
(1) Name and business address;(2) Present principal business activity, occupation, or employment, including position and office held, and the name, principal business, and address of any corporation or other organization in which the employment is carried on;(3) Material occupations, positions, offices, or employment during the last five years, giving the starting and ending dates of each and the name, principal business, and address of any business corporation or other organization in which each occupation, position, office, or employment was carried on. If any occupation, position, office, or employment required licensing by or registration with any federal, state, or municipal governmental agency, indicate that fact, the current status of the license or registration, and an explanation of any surrender, revocation, suspension, or disciplinary proceedings in connection with the license or registration; and(4) Excluding minor traffic violations, whether or not the person has been convicted of a crime during the ten years preceding the date of filing and the date, nature of conviction, name and location of court, and the penalty imposed or other disposition of the case.S.D. Admin. R. 20:06:09:30
20 SDR 36, effective 9/19/1993.42 SDR 83, effective 12/3/2015General Authority: SDCL 58-5A-70.
Law Implemented: SDCL 58-5A-70.