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Application To Add New Officer To A Corporation 13A-7 - California
| Application To Add New Officer To A Corporation Form. This is a California form and can be used in Contractors State License Board Statewide . |
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CONTRACTORS STATE LICENSE BOARD 9821 Business Park Drive, Sacramento, CA 95827 Mailing Address: P.O. Box 26000, Sacramento, CA 95826 800.321.CSLB (2752) | www.cslb.ca.gov | CheckTheLicenseFirst.com STATE OF CALIFORNIA Governor Edmund G. Brown Jr. IMPORTANT NOTICE REGARDING CONVICTIONS PLEASE READ CAREFULLY Failure to accurately report a conviction can result in an application being denied. In this notice and on the application, the term "conviction" includes pleading guilty or no contest to (nolo contendere) or being convicted by a court of any misdemeanor or felony in this state or elsewhere. As part of the Contractors State License Board (CSLB) application process, you must be fingerprinted if you have not been fingerprinted by CSLB before or if your previous fingerprint record was purged by CSLB due to a voided application or some other reason. After an application is accepted by CSLB as complete (also known as "posted"), each individual listed on the application will be sent instructions on the process for obtaining and submitting fingerprints, as required by law. Your fingerprints will be compared to the records of the California Department of Justice and the Federal Bureau of Investigation. If you have ever been convicted of a crime, your criminal record information will be reported to CSLB. This includes DUIs and other Vehicle Code violations resulting in a misdemeanor or felony conviction. Even if you have had your record expunged (charges reduced or dismissed), the past conviction will still be reported to CSLB and must be disclosed on the application. If you have ever been convicted of a crime (misdemeanor or felony), you MUST answer "Yes" to the criminal conviction question on the application and provide a detailed explanation of the circumstances resulting in your conviction. To help ensure that you provide the required information, you should complete and submit the Disclosure Statement Regarding Criminal Plea/Conviction (form 13A-45) that is available on CSLB's website. Applicants with criminal convictions are not automatically denied licensure each application is reviewed individually based on applicable sections of law. When reviewing criminal convictions, CSLB considers factors such as the nature and severity of the crimes, the amount of time that has passed since the convictions, and any evidence of rehabilitation submitted by the applicant. For rehabilitation evaluation, pursuant to the California Code of Regulations Section 869, CSLB is generally looking for three (3) years to have passed after a misdemeanor conviction and seven (7) years to have passed after a felony conviction, without further violation of law. These timeframes are calculated from the applicant's date of release from incarceration or from the end of probation if no time was served, and are subject to reduction or extension based on several factors, including the nature of the applicant's conviction history as a whole. In addition, any type of conviction could be considered substantially related to the qualifications or duties of a contractor license when evaluated in the context of the applicant's entire conviction record. Failure to accurately report any and all convictions is falsification of your application and is grounds for denial. If your application is denied, you will be prevented from filing another application for a minimum of one (1) year, up to a maximum of five (5) years. 13A-7 (rev. 05/2012) American LegalNet, Inc. www.FormsWorkFlow.com FOR CSLB USE ONLY STATE OF CALIFORNIA 9821 Business Park Drive, Sacramento, CA 95827 Governor Edmund G. Brown Jr. Mailing Address: P.O. Box 26000, Sacramento, CA 95826 800-321-CSLB (2752) | www.cslb.ca.gov | CheckTheLicenseFirst.com CONTRACTORS STATE LICENSE BOARD Application to Add New Officer to a Corporation No Fee Use this application only to add a NEW corporate officer to an existing corporate license. Use one form for each new officer. Each additional officer must use a separate form. If you have additional licenses with the same corporate registration number, you must submit a copy of this form for each license. All licenses using the same corporate registration number must show the same corporate officers. To report a change of corporate title for current officers on this license, use form 13A-7a Application to Report Change of Corporate Title for Current Officer of a Corporation. To disassociate an officer, including a responsible managing officer (RMO) or responsible managing employee (RME), use form 13M-5 Disassociation Request. To replace a current RMO or RME, use form 13A-2a Application for Replacing the Qualifying Individual. Please type or print neatly and legibly in black or dark blue ink. SECTION 1 BUSINESS NAME AND ADDRESS Please provide the full legal business name as it appears on the license. P.O. Boxes and private mail boxes (PMB) are not acceptable for the street address. 1. FULL BUSINESS NAME 2. CSLB LICENSE NUMBER 3. CORPORATE REGISTRATION NUMBER 4. BUSINESS MAILING ADDRESS Number/Street or P.O. Box City State ZIP Code 5. BUSINESS STREET ADDRESS Number/Street Only NO P.O. Boxes or PMBs City State ZIP Code 6. BUSINESS PHONE NUMBER BUSINESS FAX NUMBER BUSINESS EMAIL ADDRESS ( ) ( ) SECTION 2 NEW OFFICER'S FULL LEGAL NAME AND ADDRESS Please provide the full legal name of the corporate officer. If the individual does not have a middle name, write "None" or "No Middle Name" in the space provided. If the individual has only an initial for his or her first or middle name, write "(Initial Only)" after the initial. 7. NEW OFFICER'S FULL LEGAL NAME Last First Middle DATE OF BIRTH SOCIAL SECURITY NUMBER RESIDENCE ADDRESS Number/Street Only NO P.O. Boxes or PMBs City State ZIP Code CORPORATE TITLE(S) May NOT be an RMO or RME (see above) HOME PHONE NUMBER DRIVER LICENSE NUMBER ( ) I/we certify under penalty of perjury under the laws of the State of California that all statements, answers, and representations made in this application, including all supplementary statements attached hereto, are true and accurate, and that I/we have reviewed the entire contents of this application. (The definition of "perjury" is telling a lie while under oath.) I/we authorize the Franchise Tax Board to provide CSLB with required tax information pursuant to B&P Code Section 7145.5. Date Signature of NEW Corporate Officer Printed Name of New Corporate Officer Date Signature of Corporate Officer Currently Listed on License
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