(a) In
order to complete the online application, the applicant shall provide the following
information:
(1) Application type. The
"application type" of the application to be completed by an applicant for a title
marketing representative certificate of registration is "certificate."
(2) License type. The license type that must be
selected in order to apply for a title marketing representative certificate of
registration is Title Marketing Representative.
(3) Full legal name.
(4) Residence, business, mailing and email
addresses. The business and mailing addresses specified by the applicant are matters
of public record and shall be available to the public.
(5) Gender.
(6) Social security number.
(7) Date of birth.
(8) Country of citizenship. In addition to
completing the online application, an applicant indicating on the online application
that he or she is not a citizen of the United States must submit to the Department's
Producer Licensing Bureau a copy of his or her authorization to work in the United
States.
(9) Employment history for the
previous five years. The applicant must enter the name of each employer, the month
and year employment began, the month and year employment ended, and the position
held for all employment experiences starting with their current employer and
continuing in reverse chronological order through the date that is five years before
the date the online application is being completed. The applicant must include any
and all full-time employment, part-time employment, self-employment, military
service, periods of unemployment, and periods during which the applicant was a
full-time student.
(10) Past licensing
history. The applicant must account for all current and past insurance licenses he
or she has held as a resident or as a non-resident in California or in any other
state. For each such license, the applicant must indicate the license type, the
state or province that issued the license, the period of time during which the
license was or has been held, and whether or not the license is currently in
force.
(11) Background information. The
applicant must answer "yes" or "no" to the following background questions on the
online application:
(A) Have you ever been
convicted of a felony?
1. The online application
will advise the applicant as follows: "For the purpose of this application, you have
been 'convicted' if you were ever found guilty by verdict of a judge or jury; and/or
ever entered a plea of guilty, nolo contendere or no contest. You must disclose all
convictions, even if the charges were later dismissed or expunged, your guilty plea
was withdrawn pursuant to Penal Code Section
1203.4, or you were
placed on probation, received a suspended sentence or just ordered to pay a fine. If
you fail to disclose all convictions, your application may be denied. You may
exclude juvenile offenses tried in juvenile court."
2. If the answer to the above background question
is "Yes," the applicant, in addition to completing the online application, must
submit to the Department's Producer Licensing Bureau:
a. a written statement, with original signature,
explaining the circumstances of each conviction or charge; and
b. certified copies of the charging documents, and
of the court documents which detail the conviction, resolution of the charges,
probation and any final judgment.
An applicant who is required to submit any such certified copy
but who does not have it at his or her disposal must retain for his or her records
copies of the correspondence the applicant sends to the court or other source of
documents in order to obtain the required certified copy. Failure to provide to the
Department either copies of this correspondence, or the required certified copies of
the charging documents and court documents, upon the Department's request shall
result in the applicant's application being deemed incomplete and the suspension of
the applicant's authority to operate as a representative on a provisional basis. The
online application will advise the applicant of the requirement that, unless and
until the required certified copies of the charging documents and court documents
are in his or her possession, the applicant must retain copies of this
correspondence and that the applicant may lose his or her provisional authority if
he or she fails to furnish such copies upon
request.
(B)
Have you ever been convicted of a felony involving dishonesty or breach of trust?
1.
a. The online
application will advise the applicant as follows: Federal law (18 U.S.C. 1033) prohibits
anyone who has been convicted of a felony involving dishonesty or a breach of trust
or who has been convicted of any violation of
18 U.S.C.
1033 from conducting the business of insurance
unless they have obtained the written consent of the Insurance Commissioner. It is a
violation of this statute to conduct business of insurance without the
Commissioner's written consent. If you have been convicted of a felony involving
dishonesty or a breach of trust or a violation of
18 U.S.C.
1033, you must attach a copy of this consent. If
you have not obtained this written consent you must do so prior to filing your
application.
b. If the answer to the
above background question is "Yes," the applicant must further answer "yes" or "no"
to the following question: "Have you received consent from the Insurance
Commissioner?"
2.
a. The online application will advise the
applicant as follows: "For the purpose of this application, you have been
'convicted' if you were ever found guilty by verdict of a judge or jury; and/or ever
entered a plea of guilty, nolo contendere or no contest. You must disclose all
convictions, even if the charges were later dismissed or expunged, your guilty plea
was withdrawn pursuant to Penal Code Section
1203.4, or you were
placed on probation, received a suspended sentence or just ordered to pay a fine. If
you fail to disclose all convictions, your application may be denied. You may
exclude juvenile offenses tried in juvenile court."
b. If the answer to the question "Have you ever
been convicted of a felony involving dishonesty or breach of trust?" is "Yes," the
applicant, in addition to completing the online application, must submit to the
Department's Producer Licensing Bureau:
A. a
written statement, with original signature, explaining the circumstances of each
conviction or charge; and
B. certified
copies of the charging documents, and of the court documents which detail the
conviction, resolution of the charges, probation and any final judgment.
An applicant who is required to submit any such certified copy
but who does not have it at his or her disposal must retain for his or her records
copies of the correspondence the applicant sends to the court or other source of
documents in order to obtain the required certified copy. Failure to provide to the
Department either copies of this correspondence, or the required certified copies of
the charging documents and court documents, upon the Department's request shall
result in the applicant's application being deemed incomplete and the suspension of
the applicant's authority to operate as a representative on a provisional basis. The
online application will advise the applicant of the requirement that, unless and
until the required certified copies of the charging documents and court documents
are in his or her possession, the applicant must retain copies of this
correspondence and that the applicant may lose his or her provisional authority if
he or she fails to furnish such copies upon
request.
(C) Have you ever been convicted of a misdemeanor?
1. The online application will advise the
applicant as follows: "For the purpose of this application, you have been
'convicted' if you were ever found guilty by verdict of a judge or jury; and/or ever
entered a plea of guilty, nolo contendere or no contest. You must disclose all
convictions, even if the charges were later dismissed or expunged, your guilty plea
was withdrawn pursuant to Penal Code Section
1203.4, or you were
placed on probation, received a suspended sentence or just ordered to pay a fine. If
you fail to disclose all convictions, your application may be denied. You may
exclude juvenile offenses tried in juvenile court."
2. If the answer to the above background question
is "Yes," the applicant, in addition to completing the online application, must
submit to the Department's Producer Licensing Bureau:
a. a written statement, with original signature,
explaining the circumstances of each conviction or charge; and
b. certified copies of the charging documents, and
of the court documents which detail the conviction, resolution of the charges,
probation and any final judgment.
An applicant who is required to submit any such certified copy
but who does not have it at his or her disposal must retain for his or her records
copies of the correspondence the applicant sends to the court or other source of
documents in order to obtain the required certified copy. Failure to provide to the
Department either copies of this correspondence, or the required certified copies of
the charging documents and court documents, upon the Department's request shall
result in the applicant's application being deemed incomplete and the suspension of
the applicant's authority to operate as a representative on a provisional basis. The
online application will advise the applicant of the requirement that, unless and
until the required certified copies of the charging documents and court documents
are in his or her possession, the applicant must retain copies of this
correspondence and that the applicant may lose his or her provisional authority if
he or she fails to furnish such copies upon
request.
(D)
Have you ever been convicted of a military offense?
1. The online application will advise the
applicant as follows: "For the purpose of this application, you have been
'convicted' if you were ever found guilty by verdict of a judge or jury; and/or ever
entered a plea of guilty, nolo contendere or no contest. You must disclose all
convictions, even if the charges were later dismissed or expunged, your guilty plea
was withdrawn pursuant to Penal Code Section
1203.4, or you were
placed on probation, received a suspended sentence or just ordered to pay a fine. If
you fail to disclose all convictions, your application may be denied. You may
exclude juvenile offenses tried in juvenile court."
2. If the answer to the above background question
is "Yes," the applicant, in addition to completing the online application, must
submit to the Department's Producer Licensing Bureau:
a. a written statement, with original signature,
explaining the circumstances of each conviction or charge; and
b. certified copies of the charging documents, and
of the court documents which detail the conviction, resolution of the charges,
probation and any final judgment.
An applicant who is required to submit any such certified copy
but who does not have it at his or her disposal must retain for his or her records
copies of the correspondence the applicant sends to the court or other source of
documents in order to obtain the required certified copy. Failure to provide to the
Department either copies of this correspondence, or the required certified copies of
the charging documents and court documents, upon the Department's request shall
result in the applicant's application being deemed incomplete and the suspension of
the applicant's authority to operate as a representative on a provisional basis. The
online application will advise the applicant of the requirement that, unless and
until the required certified copies of the charging documents and court documents
are in his or her possession, the applicant must retain copies of this
correspondence and that the applicant may lose his or her provisional authority if
he or she fails to furnish such copies upon
request.
(E)
Are you currently charged with committing a crime?
1. The online application will advise the
applicant as follows: " 'Crime' includes a felony, a misdemeanor or a military
offense. You may exclude traffic citations but must include driving offenses such
as, but not limited to, reckless driving, driving under the influence and driving
with a suspended license."
2. If the
answer to the above background question is "Yes," the applicant, in addition to
completing the online application, must submit to the Department's Producer
Licensing Bureau:
a. a written statement, with
original signature, explaining the circumstances of each charge; and
b. certified copies of the charging documents.
An applicant who is required to submit any such certified copy
but who does not have it at his or her disposal must retain for his or her records
copies of the correspondence the applicant sends to the court or other source of
documents in order to obtain the required certified copy. Failure to provide to the
Department either copies of this correspondence, or the required certified copies of
the charging documents, upon the Department's request shall result in the
applicant's application being deemed incomplete and the suspension of the
applicant's authority to operate as a representative on a provisional basis. The
online application will advise the applicant of the requirement that, unless and
until the required certified copies of the charging documents are in his or her
possession, the applicant must retain copies of this correspondence and that the
applicant may lose his or her provisional authority if he or she fails to furnish
such copies upon request.
(F) Have you ever been involved in an
administrative proceeding (including matters with the Department of Insurance)
regarding any professional or occupational license?
1. The online application will advise the
applicant as follows: " 'Involved' means having a license censured, suspended,
revoked, cancelled, terminated; or being assessed a fine, placed on probation or
surrendering a license to resolve an administrative action. 'Involved' also means
being named a party to an administrative or arbitration proceeding which is related
to a professional or occupational license. 'Involved' also means having a license
application denied or the act of withdrawing an application to avoid denial. You may
exclude terminations due solely to noncompliance with continuing education
requirements or failure to pay a renewal fee."
2. If the answer to the above background question
is "Yes," the applicant, in addition to completing the online application, must
submit to the Department's Producer Licensing Bureau:
a. a written statement, with original signature,
explaining the circumstances of each disciplinary incident; and
b. certified copies of the Notices of Hearing or
other documents that state the charges and allegations, and of the documents which
demonstrate the resolution of the charges or any final judgment.
An applicant who is required to submit any such certified copy
but who does not have it at his or her disposal must retain for his or her records
copies of the correspondence the applicant sends to the court or other source of
documents in order to obtain the required certified copy. Failure to provide to the
Department either copies of this correspondence, or the required certified copies of
the Notices of Hearing and other documents, upon the Department's request shall
result in the applicant's application being deemed incomplete and the suspension of
the applicant's authority to operate as a representative on a provisional basis. The
online application will advise the applicant of the requirement that, unless and
until the required certified copies of the Notices of Hearing and other documents
are in his or her possession, the applicant must retain copies of this
correspondence and that the applicant may lose his or her provisional authority if
he or she fails to furnish such copies upon
request.
(G)
Has any business in which you were an owner, partner, officer or director ever been
involved in an administrative proceeding (including matters with the Department of
Insurance) regarding any professional or occupational license?
1. The online application will advise the
applicant as follows: " 'Involved' means having a license censured, suspended,
revoked, cancelled, terminated; or being assessed a fine, placed on probation or
surrendering a license to resolve an administrative action. 'Involved' also means
being named a party to an administrative or arbitration proceeding which is related
to a professional or occupational license. 'Involved' also means having a license
application denied or the act of withdrawing an application to avoid denial. You may
exclude terminations due solely to noncompliance with continuing education
requirements or failure to pay a renewal fee."
2. If the answer to the above background question
is "Yes," the applicant, in addition to completing the online application, must
submit to the Department's Producer Licensing Bureau:
a. a written statement, with original signature,
explaining the circumstances of each disciplinary incident; and
b. certified copies of the Notices of Hearing or
other documents that state the charges and allegations, and of any documents which
demonstrate the resolution of the charges or any final judgment.
An applicant who is required to submit any such certified copy
but who does not have it at his or her disposal must retain for his or her records
copies of the correspondence the applicant sends to the court or other source of
documents in order to obtain the required certified copy. Failure to provide to the
Department either copies of this correspondence, or the required certified copies of
the Notices of Hearing or other documents, upon the Department's request shall
result in the applicant's application being deemed incomplete and the suspension of
the applicant's authority to operate as a representative on a provisional basis. The
online application will advise the applicant of the requirement that, unless and
until the required certified copies of the Notices of Hearing or other documents are
in his or her possession, the applicant must retain copies of this correspondence
and that the applicant may lose his or her provisional authority if he or she fails
to furnish such copies upon request.
(H) Has any demand been made or judgment rendered
against you for any overdue monies by an insurer, insured, or producer, or have you
ever been subject to a bankruptcy proceeding?
1.
The online application will advise the applicant as follows: "Include only
bankruptcies that involve funds held on behalf of others."
2. If the answer to the above background question
is "Yes," the applicant, in addition to completing the online application, must
submit to the Department's Producer Licensing Bureau a statement, with an original
signature, summarizing the details of the indebtedness and arrangements for
repayment, and/or type and location of bankruptcy.
(I) Have you ever been notified by any
jurisdiction of any delinquent tax obligation that is not the subject of a repayment
agreement?
If the answer to the above question is "Yes," the applicant must
identify all such jurisdictions on the online application.
(J) Are you currently a party to or have you ever
been found liable in any lawsuit or arbitration proceeding involving allegations of
fraud, misappropriation or conversion of funds, misrepresentation or breach of
fiduciary duty?
1. If the answer to the above
question is "Yes," the applicant, in addition to completing the online application,
must for each such lawsuit or proceeding submit to the Department's Producer
Licensing Bureau:
a. a written statement, with
original signature, summarizing the details of the incident;
b. a copy of the Petition, Complaint, or other
document that commenced the lawsuit or arbitration; and
c. a copy of any official document which
demonstrates the resolution of the charges or any final
judgment.
2. An applicant who
is required to submit a copy of any document required pursuant to subitem
(a)(11)(J)1.b. or (a)(11)(J)1.c. above but who does not have such a copy at his or
her disposal must retain for his or her records copies of the correspondence the
applicant sends to the court or other source of documents in order to obtain the
copy of the document that is required pursuant to subitem (a)(11)(J)1.b. or
(a)(11)(J)1.c. Failure to provide to the Department either copies of this
correspondence, or the copies of the documents that are required pursuant to subitem
(a)(11)(J)1.b. or (a)(11)(J)1.c, upon the Department's request shall result in the
applicant's application being deemed incomplete and the suspension of the
applicant's authority to operate as a representative on a provisional basis. The
online application will advise the applicant of the requirement that, unless and
until the copies of the documents that are required pursuant to subitem
(a)(11)(J)1.b. or (a)(11)(J)1.c are in his or her possession, the applicant must
retain copies of this correspondence and that the applicant may lose his or her
provisional authority if he or she fails to furnish such copies upon
request.
(K) Have you or any
business in which you are or were an owner, partner, officer, or director ever had
an insurance agency contract or any other business relationship with an insurance
company terminated for any alleged misconduct?
If the answer to the above question is "Yes," the applicant, in
addition to completing the online application, must for each such termination submit
to the Department's Producer Licensing Bureau:
1. a written statement, with original signature,
summarizing the details of the incident and explaining why the applicant feels this
incident should not prevent him or her from receiving a title marketing
representative certificate of registration; and,
2. copies of any relevant
documents.
(12)
Applicant's certification. The applicant must certify the under penalty of perjury
that the applicant had read the online application, that the applicant knows the
contents of the information he or she has provided on the online application, and
that each statement made on the online application is full, true and correct. The
required certification includes language indicating that the applicant understands
that pursuant to section
1738, and subdivision (h) of section
1668, of the
Insurance Code, any false statement made on the application or any document filed in
support thereof may subject the applicant's application to denial and may subject
the applicant's certificate to suspension or revocation.
