B. An application for an original license as a broker or salesperson shall set forth:

1. 1. The applicant's address of record and legal name and any derivative of the applicant's first name or middle name or a nickname that the applicant regularly uses for advertising purposes.
2. 2. Whether the applicant has ever been convicted of a felony and, if so, the nature of the felony, where and when the felony was committed and the disposition of the conviction, or whether the applicant has been disbarred or suspended from the practice of law.
3. 3. Whether the applicant has ever been refused a broker's or salesperson's license or any other occupational license in this or any other state, whether the applicant's license as a broker or salesperson has been revoked or suspended in this or any other state or whether the applicant has had any other occupational or professional license, certificate or registration revoked or suspended in this or any other state.
4. 4. The name of any corporation, company or partnership that is or ever has been licensed by the department in which the applicant exercised any control.
5. 5. If the applicant is a natural person, the applicant's social security number. If the applicant, due to bona fide religious convictions or other bona fide reasons that the applicant documents on the application to the satisfaction of the commissioner, does not have a social security number, the applicant may provide the applicant's federal tax identification number with the application. The state real estate department shall use the applicant's social security number or federal tax identification number to aid the department of economic security in locating noncustodial parents or the assets of noncustodial parents, and for no other purpose.

C. An application for a license as a broker additionally shall set forth:

1. 1. The name under which the business is to be conducted.
2. 2. The applicant's address of record.

D. An applicant for a broker's or salesperson's license shall provide information that the commissioner determines is reasonably necessary. The information may include:

1. 1. Prior criminal records.
2. 2. A valid fingerprint clearance card issued pursuant to section 41-1758.03.
3. 3. An affidavit setting out whether the applicant has participated in, operated or held an interest in any land development company that has filed, or is subject to, a petition under any chapter of the federal bankruptcy act.