Minnesota Department of Labor and Industry Construction Codes and Licensing Division Licensing and Certification Services / Residential PO Box 64217 St. Paul MN 55164-0217 E-mail Web Site Phone Reset DLI. License state. mn.us www. dli. mn.gov/ccld. asp 651 284-5034 Background Disclosure Form Business / Contractor / Qualifying Person This form must be completed by every APPLICANT. License state. mn.us www. dli. mn.gov/ccld. asp 651 284-5034 Backgr.

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How to fill out the MN Background Disclosure Form online

Filling out the MN Background Disclosure Form is an essential step for applicants seeking licensure in various construction-related fields in Minnesota. This guide provides clear and supportive instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the MN Background Disclosure Form online

  1. Click the 'Get Form' button to obtain the form and open it for editing.
  2. Enter your last name, first name, and middle name in the designated fields.
  3. Provide your physical street address (no PO Box), city, state, zip code, and county.
  4. Input your date of birth in the required field.
  5. List your legal business name and any doing business as (DBA) name, if applicable.
  6. Include your telephone number to ensure the department can contact you if needed.
  7. Complete the work history section for the past five years, detailing the business name, dates of employment, and description of your role. Attach additional pages if necessary.
  8. Answer the yes/no questions regarding your occupational or professional licenses, administrative actions, criminal offenses, civil judgements, bankruptcy filings, and changes in business ownership. If you answer yes to any question, attach relevant documentation.
  9. Sign and date the form, certifying that all information provided is true and complete. Ensure you also enter your title in the designated field.
  10. After completing the form, save your changes, and download or print the document for submission.

Complete your MN Background Disclosure Form online today to ensure your application process is smooth and efficient.

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