Form DBO-3 "Confidential Resume Submitted to the Commissioner of Business Oversight, State of California" - California

What Is Form DBO-3?

This is a legal form that was released by the California Department of Business Oversight - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2019;
  • The latest edition provided by the California Department of Business Oversight;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DBO-3 by clicking the link below or browse more documents and templates provided by the California Department of Business Oversight.

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Download Form DBO-3 "Confidential Resume Submitted to the Commissioner of Business Oversight, State of California" - California

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STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
CONFIDENTIAL RESUME SUBMITTED TO THE COMMISSIONER OF BUSINESS
DBO-3 (Rev. 1-19)
OVERSIGHT, STATE OF CALIFORNIA
If space provided is not sufficient, insert supplemental page with appropriate references thereto.
1.
Full Name
Have you ever used (or been known under) any other name or names?
2.
California Driver's License Number
3.
Residence address
(If you have lived at this address for less than ten years, please list former residence addresses and dates
occupied for the past ten years.)
4.
Business address
Business phone
5.
Date of birth
Place of birth
6.
Years resident of community
Marital status
7.
What is your present occupation or business affiliation? (in detail)
8.
What were your former occupations or business affiliations? (in detail)
9.
Have you ever been arrested for other than minor traffic violations? ________ (If the answer to
question 9 is affirmative, please attach a statement giving the full details including final disposition of
each case.)
10. Has any corporation in which you have been a director, officer, or substantial stockholder, or
has any other form of business organization (including, but not limited to, partnerships, joint
ventures and sole proprietorships) with which you have been associated or employed in any
management capacity, ever been subject to criminal prosecution? ______________________
(If so, please attach a statement giving the full details and final disposition thereof.)
11. Have you, or has any corporation in which you have been a director, officer or substantial
stockholder, or has any other form of business organization (including, but not limited to,
partnerships, joint ventures and sole proprietorships) with which you have been associated or
employed in any management capacity ever been:
(a) licensed to engage in any business or profession by any government agency?
(b) refused a license to engage in any business or profession by any government agency, or
has any such license ever been suspended or revoked?
(c) bankrupt, forced into liquidation, placed in receivership, or subject to similar proceedings?
(d) named in any order, judgment or decree of any court, government agency or
administrator, temporarily or permanently restrained or enjoined from engaging in or
continuing any conduct, practice or employment?
(e) refused a bond or had a bond revoked or canceled? __________________________________
(If the answer to any part of question 11 is affirmative, please attach a statement giving the full details.)
12. Are you, or is any corporation in which you have been a director, officer or substantial
stockholder, or is any other form of business organization (including, but not limited to,
partnerships, joint ventures and sole proprietorships) with which you have been associated or
employed in any management capacity, a party to any civil action now pending? ___________
(If so, attach statement giving full details.)
The above information is certified to be complete and correct to the best of my knowledge.
Dated:
, 20
Signature:
STATE OF CALIFORNIA – DEPARTMENT OF BUSINESS OVERSIGHT
CONFIDENTIAL RESUME SUBMITTED TO THE COMMISSIONER OF BUSINESS
DBO-3 (Rev. 1-19)
OVERSIGHT, STATE OF CALIFORNIA
If space provided is not sufficient, insert supplemental page with appropriate references thereto.
1.
Full Name
Have you ever used (or been known under) any other name or names?
2.
California Driver's License Number
3.
Residence address
(If you have lived at this address for less than ten years, please list former residence addresses and dates
occupied for the past ten years.)
4.
Business address
Business phone
5.
Date of birth
Place of birth
6.
Years resident of community
Marital status
7.
What is your present occupation or business affiliation? (in detail)
8.
What were your former occupations or business affiliations? (in detail)
9.
Have you ever been arrested for other than minor traffic violations? ________ (If the answer to
question 9 is affirmative, please attach a statement giving the full details including final disposition of
each case.)
10. Has any corporation in which you have been a director, officer, or substantial stockholder, or
has any other form of business organization (including, but not limited to, partnerships, joint
ventures and sole proprietorships) with which you have been associated or employed in any
management capacity, ever been subject to criminal prosecution? ______________________
(If so, please attach a statement giving the full details and final disposition thereof.)
11. Have you, or has any corporation in which you have been a director, officer or substantial
stockholder, or has any other form of business organization (including, but not limited to,
partnerships, joint ventures and sole proprietorships) with which you have been associated or
employed in any management capacity ever been:
(a) licensed to engage in any business or profession by any government agency?
(b) refused a license to engage in any business or profession by any government agency, or
has any such license ever been suspended or revoked?
(c) bankrupt, forced into liquidation, placed in receivership, or subject to similar proceedings?
(d) named in any order, judgment or decree of any court, government agency or
administrator, temporarily or permanently restrained or enjoined from engaging in or
continuing any conduct, practice or employment?
(e) refused a bond or had a bond revoked or canceled? __________________________________
(If the answer to any part of question 11 is affirmative, please attach a statement giving the full details.)
12. Are you, or is any corporation in which you have been a director, officer or substantial
stockholder, or is any other form of business organization (including, but not limited to,
partnerships, joint ventures and sole proprietorships) with which you have been associated or
employed in any management capacity, a party to any civil action now pending? ___________
(If so, attach statement giving full details.)
The above information is certified to be complete and correct to the best of my knowledge.
Dated:
, 20
Signature:
STATE OF CALIFORNIA–DEPARTMENT OF BUSINESS OVERSIGHT
CONFIDENTIAL RESUME SUBMITTED TO THE COMMISSIONER OF BUSINESS
DBO-3 (Rev. 1-19) Page 2 of 2
OVERSIGHT, STATE OF CALIFORNIA
Notice to Individuals – Use of Information
The Commissioner of Business Oversight (the “Commissioner”) is authorized by the Financial Code to
gather and maintain the information requested in the form you have accessed. If the form is submitted
in connection with any application or other matter before the Commissioner, the requested information
is deemed necessary to process that application or other matter pursuant to the Financial Code. If the
requested information is not accurately and completely provided, the application may be denied, or the
other matter may be resolved against your interests.
If the form requests you to provide your social security account number, please be advised that
providing your social security account number is voluntary. Your social security account number will
be used as an identifier, and may be used to verify information provided to the Department of
Business Oversight (the “Department”). Failure to provide your social security number may require
the Department to use other methods to verify information, which may cause delays in processing
this information and any related application or other matter. If the information you have provided to
the Department cannot be verified, the Department may reject your filing and deny any related
application or cause any other matter to be resolved against your interests. In addition, the
Commissioner may request additional information or clarification of submitted information.
You may be required to provide your fingerprints in conjunction with submitting your personal
information. If your fingerprints are required, the Department will provide you with the necessary
instructions and, if applicable, the forms upon which your fingerprints may be submitted.
In processing the information you provide, the Department may cause a consumer credit report to be
prepared in accordance with the provisions of Title 1.6, Part 4, Division Third of the Civil Code
(commencing at Section 1785.1), or an investigative consumer report to be prepared in accordance
with the provisions of Title 1.6A, Part 4, Division Third of the Civil Code (commencing at Section
1786), or the respective successor statutes.
The information you provide the Department will be held in confidence as required by the
Information Practices Act (Civil Code Section 1798, et seq.). The Information Practices Act
provides that the Department may share the information you provide with the Department of
Insurance, the Department’s Division of Corporations, other federal and state financial institution
regulators, law enforcement agencies, or any other governmental entity if the disclosure is required
under state or federal law. In addition, the Department may share the information you provide with
any such agency if the disclosure assists the agency in discharging its duties.
DBO’s Privacy Notice on Collection
DBO Collects and Uses Personal Information: The DBO collects the information requested on this form
as authorized by Chapter 1 of Title 10 of the California Code of Regulations. The DBO uses this information
to process applications related to entities authorized to engage in business under the Financial Institutions
Law. Use of the personal Information DBO collects is subject to limitations contained in the Information
Practices Act of 1977 and other applicable state and federal laws.
Providing Personal Information Is Mandatory: When providing information or documents, please do not
include unrequested personal information such as a Social Security number, driver’s license number, or
financial information.
DBO May Disclose Your Personal Information: We may share your personal information with other federal
and state financial institution regulators, or any law enforcement agency. Your personal information may also
be disclosed:
In response to a Public Records Act request, as allowed by the Information Practices Act.
To another governmental agency as required by state or federal law.
In response to a court order or administrative order, a subpoena or a search warrant.
Your Access to Your Personal Information: You may review the records maintained by DBO that contain
your personal information. To request access, contact: DBO Privacy Officer, 1515 K Street, Sacramento,
CA 95814, (866) 275-2677.
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