(a) Application for a license shall be made on an application form to be furnished by the department. An applicant shall provide the following information:

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Terms Used In Hawaii Revised Statutes 451K-11

(1) The applicant’s legal name;
(2) The applicant’s current residence and business mailing addresses and phone numbers;
(3) The applicant’s social security number;
(4) The date and place of any conviction of a penal crime directly related to the profession or vocation in which the applicant is applying for licensure, unless the conviction has been expunged or annulled, or is otherwise precluded from consideration by section 831-3.1;
(5) Proof that the applicant is a United States citizen, a permanent resident, or is otherwise authorized to work in the United States;
(6) Disclosure of similar licensure in any state or territory;
(7) Disclosure of disciplinary action by any state or territory against any license held by the applicant; and
(8) Any other information the licensing authority may require to investigate the applicant’s qualifications for licensure.
(b) Failure to provide the information required by subsection (a) and pay the required fees shall be grounds to deny the application for licensure.

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