1.__Form.__An application for a license required under this chapter must be on a form provided by the Chief of the State Police.__The application must be signed by the individual applicant or by a duly authorized officer of the partnership, corporation or association applying for the license.__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 partnership, corporation 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 or for a misdemeanor crime of domestic violence?"

(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 or would constitute a misdemeanor crime of domestic violence?"

(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 discharged from the United States Armed Forces under dishonorable circumstances within the past 5 years?"

(7)__"Are you an illegal alien?"