Peddlers, Solicitors, & Canvassers License Application

Village of Roscoe Ordinance Section 111.18 requires the following information to be submitted with your application.

A fingerprint-based criminal history check (available at http://isp.state.il.us/crimhistory/chri.cfm).
Copy of current driver’s license or valid photo id.
Application signed and dated by employer and applicant.

Date of Application
Date Format: MM slash DD slash YYYY
Name of Company
Employer's Name
Employer's Address
Street, City, State, Zip
Employer's Phone Number
Applicant's Name*
First Last
Alias
Maiden Name
Present Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Former Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Applicant's Phone Number
Place of Birth
City, State, Zip
Have you been a resident of Illinois continuously for one year prior to date of this application?
- Yes
- No
CRIMINAL RECORD
Criminal Record
List all felony crimes you have been arrested and convicted of, other than traffic offenses in which the penalty was less than $75.00
Date of Arrest Charge City, State of Arrest
File
Having read and answered all of the above statements and questions, I hereby consent to the investigation of such facts, and state that all of the above statements are true and correct in every way. I also consent to the revocation of my license upon demand due to any false statements upon this application.

I agree to operate in accordance with the Police regulations and ordinances of the Village of Roscoe now in force and any others that may be enacted during the duration of this license. I further understand that I may not conduct the activity applied for until a License has been granted.
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Phone
This field is for validation purposes and should be left unchanged.

Date of Arrest	Charge	City, State of Arrest