§1018. Applications

1. Form.__An application for a license required under this chapter must be on the form provided by the board.__The application must contain, but is not limited to, the following information regarding the individual applicant and each key employee, officer, director, partner, shareholder, creditor, associate or owner of any legal or beneficial interest in a person applying for a license:

A. Full name;

B. Full current address and addresses for the prior 15 years;

C. A record of previous issuances and denials of or any adverse action taken against a gambling-related license or application under this chapter or in any other jurisdiction.__ For purposes of this paragraph, "adverse action" includes, but is not limited to, a condition resulting from an administrative or criminal violation, a suspension or revocation of a license, or a voluntary surrender of a license to avoid or resolve criminal or disciplinary action;

D. All information the board determines is necessary or appropriate to determine whether the applicant satisfies the minimum qualifications specified in section 1017, subsection 1; and

E.__Any information the board by rule considers necessary.

2. Signature as certification.__The applicant, by affixing the applicant's signature to the application, certifies:

A. That the statements made in the application and any documents made a part of the application are true and correct;

B. That the applicant understands that the information provided pursuant to subsection 1 is used by the board, along with other information, in judging the applicant's suitability and that this information may be cause for refusal to issue a license; and