Edit, Download, and Sign the Background Disclosure Form for Minnesota Contractors
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How do I fill this out?
To fill out this form accurately, you'll need to provide detailed personal and professional information. Ensure all fields are completed and additional documentation is attached if necessary. A thorough and honest disclosure will expedite the licensing process.
How to fill out the Background Disclosure Form for Minnesota Contractors?
1
Provide your personal information including name, date of birth, and physical address.
2
Supply your legal business name, DBA, and contact number.
3
List your work history for the past five years.
4
Answer the six yes/no questions regarding your professional and legal history and attach necessary documentation.
5
Sign, date, and provide your title to complete the form.
Who needs the Background Disclosure Form for Minnesota Contractors?
1
Contractors applying for a license in Minnesota need this form to provide their background information.
2
Business owners in the construction industry require this form as part of the state's licensing process.
3
Qualifying individuals responsible for management or policy control must fill out this form.
4
Employees exercising authority over contracting, remodeling, or roofing activities need to complete this disclosure.
5
Affiliates, partners, directors, and shareholders involved in residential contracting activities must submit this form.
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What are the instructions for submitting this form?
To submit this form, complete all fields and attach any required documentation. You can email the completed form to DLI.license@state.mn.us or mail it to the Department of Labor and Industry at 443 Lafayette Road North, St. Paul, MN 55155. For further assistance, you can contact them at (651)284-5034. It's recommended to keep a copy of the submission for your records.
What is the purpose of this form?
The purpose of this form is to provide relevant background information required by the Minnesota Department of Labor and Industry. Contractors and business entities in the construction sector must disclose detailed personal, professional, and financial histories. Accurately completing this form ensures a thorough evaluation for licensure, maintains compliance with state regulations, and facilitates transparent business practices.
Tell me about this form and its components and fields line-by-line.
- 1. Last Name: Enter your last name as it appears on your official documents.
- 2. First Name: Enter your first name as it appears on your official documents.
- 3. Middle Name: Enter your middle name or initial if applicable.
- 4. Date of Birth: Provide your date of birth in MM/DD/YYYY format.
- 5. Physical Street Address: Enter your physical street address. PO Box addresses are not acceptable.
- 6. City: Provide the city of your physical address.
- 7. State: Provide the state of your physical address.
- 8. ZIP Code: Enter the ZIP code for your physical address.
- 9. County: Specify the county of your physical address.
- 10. Legal Business Name and DBA: Provide the legal name of your business and any DBA if applicable.
- 11. Telephone Number: Enter your contact telephone number.
- 12. Work History: List your work history for the past five years, including business name, dates of employment, and description of employment.
- 13. Occupational License: Indicate any occupational or professional licenses you have held.
- 14. Professional Action: Disclose any professional or vocational license actions taken against you.
- 15. Criminal Offense: Report any criminal offenses you've been charged with or convicted of in the past 10 years.
- 16. Civil Judgment: Disclose any civil judgments involving fraud, construction defects, or other relevant issues.
- 17. Bankruptcy Protection: Indicate if you've ever filed for bankruptcy or have unsatisfied judgments.
- 18. Business Change: Report any changes in ownership or control of your business within the last five years.
- 19. Certification: Sign and date the form to certify the accuracy of the information provided.
What happens if I fail to submit this form?
Failure to submit this form can delay or result in the denial of your application.
- Denial of License: Your application for a contractor license may be denied.
- Processing Delays: Incomplete submissions can cause delays in the processing of your application.
- Mandatory Disclosures: Required information must be disclosed to avoid penalties.
How do I know when to use this form?
- 1. First-time Applicants: Individuals applying for their first contractor license.
- 2. Renewal: Contractors renewing their licenses may need to submit this form if there have been significant changes.
- 3. Business Owners: Owners of construction businesses undergoing changes in management or ownership.
- 4. Legal Issues: Contractors who have faced legal or financial issues requiring disclosure.
- 5. Compliance: Ensuring business practices comply with state regulations.
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