Eligibility Questionnaire

In order to be considered for a collector position, you need to be able to be registered with the State of Minnesota Department of Commerce. Below is a series of questions to determine your eligibility.

1. Have you ever been convicted of a crime, had a judgement withheld or deferred, or have you been charged with committing a crime?

"Crime" includes a misdemeanor, felony, or a military offense. You may exclude misdemeanor traffic citations or convictions involving driving under the influence (DUI) or driving while intoxicated (DWI), driving without a license, reckless driving, or driving with a suspended or revoked license, and juvenile offenses. "Convicted" includes, but is not limited to, having been found guilty by verdict of a judge or jury, having entered a plea of guilty or nolo contendere, or having been given probation, a suspended sentence, or a fine.

YesNo

2. Have you or any business in which you are or were an owner, partner, officer or director, or member or manager of a limited liability company, ever been involved in an administrative proceeding regarding any professional or occupational license, or registration?

"Involved" means having a license censured, suspended, revoked, canceled, terminated; or, being assessed a fine, a cease and desist order, a prohibition order, a compliance order, placed on probation, or surrendering a license to resolve an administrative action. "Involved" also means being named as a party to an administrative, investigative, or arbitration proceeding, which is related to a professional or occupational license, including any investigation by the Minnesota Department of Commerce. "Involved" also means having a license application denied or the act of withdrawing an application to avoid a denial. You may EXCLUDE terminations due solely to noncompliance with continuing education requirements or failure to pay a renewal fee.

YesNo

3. Has any judgement been rendered against you or any business in which you are or were an owner, partner, officer, director, or member or manager of a limited liability company, for overdue monies, or have you ever been subject to a bankruptcy proceeding?

YesNo

4. Have you been notified by any jurisdiction to which you are applying of any delinquent tax obligation that is not the subject of a repayment agreement?

YesNo

5. Have you ever been party to, a defendant, or found liable in, any lawsuit or arbitration proceeding involving allegations of fraud, misappropriation or conversion of funds, misrepresentation, breach of fiduciary duty, or breach of contract?

YesNo

6. do you have a child support obligation in arrearage?

YesNo

7. Were you previously licensed in Minnesota as a debt collector?

YesNo

8. Have you ever been licensed as a debt collector in any state other than Minnesota?

YesNo

9. Is this a request to transfer your debt collector license to a new collection agency?

YesNo

10. Do you have any active licenses other than the debt collector license, including, Insurance, Real Estate, or Appraiser?

YesNo

11. Have you ever been licensed to practice law in Minnesota or any other state?

YesNo

12. Have any disciplinary proceedings been instituted against you in any of these states?

YesNo

13. Are you currently an owner, officer, or partner of a Collection Agency?

YesNo

14. Is the collection agency that the debt collector is applying under located outside of the United States?

YesNo

Signature:    Date: