California Code, Business and Professions Code - BPC § 2999.103

(1) The registrant's name, registration number, and contact information.

(2) The supervisor's name, license number, and contact information.

(3) Disclosure as to whether or not the registrant has been convicted of any violation of the law in this or any other state, the United States or its territories, military court, or other country, omitting traffic infractions under five hundred dollars ($500) not involving alcohol, a dangerous drug, or a controlled substance, since the issuance or previous renewal of their registration.

(4) Disclosure as to whether or not the registrant has had a license or registration disciplined by a governmental agency or other disciplinary body, since the issuance or previous renewal of their registration.Discipline includes, but is not limited to, suspension, revocation, voluntary surrender, probation, reprimand, or any other restriction on a license or registration held.

(5) Attestation under penalty of perjury that the information provided on the application is true and correct.

(6) The annual renewal fee for a psychological testing technician as specified in Section 2987.

(1) Shall not provide psychological testing technician services.

(2) Shall renew within 60 days after its expiration and pay the renewal and delinquency fees as specified in Section 2987, or the registration shall be canceled and a new application for registration shall be submitted to the board.