§374.__Applications

1.__Form.__An application for a license required under this chapter, except for a license to operate under section 371, must be on the form provided by the commission.__The application must contain, but is not limited to, the following information regarding the individual applicant and each officer, director, partner or owner of any interest in a corporation, partnership or association applying for a license:

A.__Full name;

B.__Full current address and addresses for the prior 5 years;

C.__A record of previous issuances of, refusals to issue and revocations of a license under this chapter; and

D.__Answers to the following questions posed in substantially the following form.

(1)__Is there a formal charging instrument now pending against you in this or any other jurisdiction for a crime that is punishable by imprisonment for one year or more?

(2)__Is there a formal charging instrument now pending against you in this or any other jurisdiction for a juvenile offense that involves conduct that, if committed by an adult, would be punishable by imprisonment for one year or more?

(3)__Have you ever been convicted of a crime described in subparagraph (1) or adjudicated as having committed a juvenile offense as described in subparagraph (2)?

(4)__Are you a fugitive from justice?

(5)__Are you a drug abuser, drug addict or drug- dependent person?

(6)__Have you been dishonorably discharged from the United States Armed Forces within the past 5 years?

(7)__Are you an illegal alien?

(8)__To your knowledge, have you been the subject of an investigation by any law enforcement agency within the