The Cannabis Employee/Interested Party Background Authorization Form is a one-page form of the City of Sacramento's Office of Cannabis Management (OCM), which sits under the City of Sacramento Finance Department. It collects an individual's contact details, the cannabis business they are tied to, and a sworn answer about past convictions. If you searched for a Sacramento business license for a cannabis business, note that this is a background form sent to OCM, not a license application. You can fill out the form online on FillingPDF and download or print the completed PDF; the city publishes the original at the official URL.
Last updated
What is Cannabis Employee/Interested Party Background Authorization Form – Sacramento, CA?
The Cannabis Employee/Interested Party Background Authorization Form is the City of Sacramento form on which an individual connected to a cannabis business gives personal details, business details and a certified answer about criminal convictions, so the Office of Cannabis Management (OCM) can review that person's background.
OCM is the city office at 915 I Street, 1st Floor, Sacramento, CA 95814, and it publishes the form among its cannabis forms. The form identifies the person (full name, phone, email, residence address, driver's license, date of birth, U.S. citizen yes or no) and the business (type, name, phone, address including suite number). It also asks whether you are an owner or have a 20% or more interest in the company, and whether you are familiar with the City of Sacramento ordinances and California laws that apply to the application.
The conviction question is broad: it covers convictions by verdict, plea of guilty, plea of no contest, fines paid and diversion programs completed, including DUI. The applicant signs under penalty of perjury. The form warns that any false or misleading answer will result in denial or revocation of any permit, and that verification of the information is a matter of public record that may be made available to interested parties on request.
The form travels with two attachments and is separate from the State of California Request for Livescan Form, a state document of which you attach a completed copy. The city's cannabis forms page also lists a Cannabis Fingerprinting Information Form and a Department of Justice request for live scan service form as other documents.
Who needs to file Cannabis Employee/Interested Party Background Authorization Form – Sacramento, CA?
The form is for individuals tied to a cannabis business whose background the City of Sacramento Office of Cannabis Management reviews. Its title names two groups: cannabis employees and interested parties. The form itself asks you to mark whether you are an owner or have a 20% or more interest in the company.
You complete it with the details of the business you are connected to. The form offers these business types:
- Manufacturing
- Cultivation
- Testing Lab
- Delivery
- Microbusiness
- Dispensary
- Distribution
Each person fills in and signs the form for himself or herself: the form has a single applicant signature line and asks the applicant to certify the answers personally. It does not describe a representative signing for someone else.
The form does not state which individuals at a business must submit it. If you are unsure whether you must, contact OCM at (916) 808-8955, the number printed on the form, or check the city's cannabis forms and checklists for the permit type involved.
When to file Cannabis Employee/Interested Party Background Authorization Form – Sacramento, CA
The form prints no due date of its own. It is remitted to the Office of Cannabis Management together with a copy of the completed State of California Request for Livescan Form and a copy of your valid government-issued ID, so it is ready to send once the Live Scan request has been completed.
Enter the date next to your signature on the day you sign. The revision printed on the form is Rev 4/2022. For any timing that applies to the permit process the form supports, such as application steps, check the city's cannabis checklists or call OCM at (916) 808-8955.
Documents you need
- A copy of the completed State of California Request for Livescan Form, sent with this form to the Office of Cannabis Management.
- A legible copy of the applicant's valid (not expired) government-issued identification.
How to fill out Cannabis Employee/Interested Party Background Authorization Form – Sacramento, CA
Print your full name
In the PRINT FULL NAME box, enter your full name. Then add your daytime phone and your email address.
Enter your residence address
Under CURRENT RESIDENCE ADDRESS, write the address where you currently live.
Add license, birth date and citizenship
Enter your driver's license information and your date of birth. Check YES or NO for U.S. CITIZEN.
Mark your ownership interest
Under ARE YOU AN OWNER OR HAVE 20% OR MORE INTEREST IN COMPANY?, check the box that applies to you.
Select the type of business
Under TYPE OF BUSINESS, check Manufacturing, Cultivation, Testing Lab, Delivery, Microbusiness, Dispensary or Distribution.
Enter the business details
Fill in BUSINESS NAME, BUSINESS PHONE and BUSINESS ADDRESS (INCLUDING SUITE NUMBER).
Answer the ordinance question
Check YES I AM or NO I AM NOT to say whether you are familiar with the City of Sacramento ordinances and California laws pertaining to the application.
Answer the conviction question
Check NO, or YES and give the date of the arrest, the offense you were charged with and the city or jurisdiction. Include convictions by verdict, guilty or no contest pleas, fines paid and completed diversion programs, including DUI.
Sign and date the certification
Read the penalty-of-perjury statement, then sign on Signature of Applicant and enter the DATE.
Review and download the PDF
Check every entry, then download or print the completed PDF from FillingPDF and assemble it with the Livescan copy and ID copy described under How to submit.
How to submit Cannabis Employee/Interested Party Background Authorization Form – Sacramento, CA
The form says to remit it to the Office of Cannabis Management at the address printed on it; it names no other channel.
- Address: Office of Cannabis Management, 915 I Street, 1st Floor, Sacramento, CA 95814.
- Phone: (916) 808-8955.
- Package: the signed form, a copy of the completed State of California Request for Livescan Form, and a legible copy of the applicant's valid (not expired) government-issued identification.
Sign and date the form before sending it, and make sure the ID copy is readable. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Sending the form without a copy of the completed State of California Request for Livescan Form.
- Attaching an expired ID or an unreadable copy; the form asks for a legible copy of valid (not expired) government-issued identification.
- Answering the conviction question "NO" when fines paid, completed diversion programs or a DUI apply; the question covers those cases.
- Marking "YES" to the conviction question without the date of the arrest, the offense charged and the city or jurisdiction.
- Leaving out the suite number in the business address; the form asks for it.
- Signing and dating nothing: submitting the form without the applicant signature and date under the perjury certification.
- Giving a false or misleading answer; the form states it will result in denial or revocation of any permit.
- Sending the form somewhere other than the Office of Cannabis Management, 915 I Street, 1st Floor, Sacramento, CA 95814.
Frequently asked questions
What is the Cannabis Employee/Interested Party Background Authorization Form?
It is a City of Sacramento form, issued by the Office of Cannabis Management, on which an employee or interested party of a cannabis business gives personal and business details and certifies, under penalty of perjury, their answer about prior convictions.
Is this a Sacramento business license application?
No. It is a background authorization form that goes to the Office of Cannabis Management with a Livescan request copy and ID. The city's cannabis forms page lists permit applications, checklists and fee documents separately from this form.
What do I attach to the background authorization form?
Attach a copy of the completed State of California Request for Livescan Form and a legible copy of your valid (not expired) government-issued identification. The form lists both items at the top, next to the OCM address.
Where do I send the cannabis background authorization form in Sacramento?
Remit it to the Office of Cannabis Management, 915 I Street, 1st Floor, Sacramento, CA 95814. The form prints no other channel. Questions can go to OCM at (916) 808-8955, the phone number printed on the form.
What counts as a conviction on this form?
The form says to include convictions by verdict, plea of guilty, plea of no contest, fines paid and diversion programs completed, including DUI. If you answer YES, give the date of the arrest, the offense charged and the city or jurisdiction.
What happens if I give a false answer on the form?
The certification states that any false or misleading answer will result in the denial or revocation of any permit. You sign it under penalty of perjury, so answer every question truthfully and completely.
Is the information on the form public?
The certification says verification of the accuracy of the information is a matter of public record and may be made available to interested parties on request. Read that statement before you sign.
Can I fill out this form online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not connected to the City of Sacramento, and does not file the form; you send it to OCM yourself.
Ready to fill out Cannabis Employee/Interested Party Background Authorization Form – Sacramento, CA?
Fill out Cannabis Employee/Interested Party Background Authorization Form – Sacramento, CA now