Professional License History
Disclose all professional, occupational, and business license history, including any denials, suspensions, reprimands, or disciplinary actions. If you hold no professional licenses, answer 'No' to each question.
License Denial / Suspension / Termination
Have you ever had any state or federal professional, occupational, or business license denied, refused renewal, suspended, withdrawn, or terminated? *
Revealed when 'Yes':
For each: License Type | Issuing Agency | Date | Reason | Disposition.
Have you ever received a reprimand or censure related to any professional, occupational, or business license? *
Are there any currently pending applications for occupational, professional, or business licenses (other than this application)?
Has your right to engage in any profession or occupation ever been disqualified, suspended, withdrawn, or terminated? *