REG 4019 Form – If you’re applying to join California’s Business Partner Automation Program (BPA Program) as a dealer, registration service, or other authorized partner, you’ll need to submit the REG 4019 Form (Statement of Personal History – Pre-Implementation Screening Process). This official California DMV form is a key requirement for anyone who will access DMV records or process vehicle transactions.
In this comprehensive guide, we cover everything you need to know about the REG 4019 PDF, including who must complete it, how to fill it out accurately, submission tips, and the direct official download link.
What Is the REG 4019 Form?
The REG 4019 Form is the Statement of Personal History Screening PDF issued by the California Department of Motor Vehicles. It collects detailed personal, employment, and criminal history information to determine an individual’s suitability for participation in the Business Partner Automation Program.
The DMV uses the form (along with possible law enforcement inquiries and interviews) to screen business owners, managers, and employees who will:
- Manage or administer transactions
- Handle inventory or money
- Process vehicle registration transactions
- Work directly with customers
Form details:
- Form number: REG 4019
- Revision: R11 (11/2002) – still the current version used by DMV as of 2026
- Purpose: Pre-implementation background screening for BPA Program access to DMV systems
Download the official REG 4019 PDF here:
https://www.dmv.ca.gov/portal/uploads/2025/05/REG-4019-R11-2002-ASB-WWW.pdf
Who Needs to Submit the REG 4019 Statement of Personal History?
You (and every relevant employee) must complete a separate REG 4019 if you are:
- Business owners, partners, or principals
- Managers or administrative staff overseeing the BPA Program
- Employees who process registrations, handle inventory, money, or customer interactions
The form is not required for the general public — it is specific to the DMV’s Business Partner Automation Program.
Why the DMV Requires the REG 4019 Form?
The DMV’s screening process protects the integrity of vehicle records and prevents unauthorized access. Key reasons include:
- Verifying criminal history (felonies and misdemeanors within the last 10 years, excluding minor traffic offenses)
- Checking employment discipline or terminations in the last 3 years
- Reviewing prior DMV licensing history (dealerships, salespersons, driving schools, etc.)
- Ensuring only suitable individuals gain system access
Important legal note: Falsification, withholding information, or incomplete answers can result in denial of participation. All convictions must be disclosed even if expunged, pardoned, or set aside.
Step-by-Step: How to Fill Out the REG 4019 PDF?
Follow these instructions exactly as printed on the form:
- Section 1 – Personal Information
Print your full legal name, residence address, county, phone numbers. - Section 2 – Physical Description
Provide birthdate, sex, hair/eye color, height, weight, California DL/ID number (if any), and any other names you’ve used. - Section 3 – Employment History
List all jobs for the last 3 years (most recent first). Include job title, dates, hours, company name, duties, and reason for leaving. - Section 4 – Prior DMV Licensing History
Disclose any previous applications or licenses as a dealer, salesperson, dismantler, driving school, etc., and any disciplinary actions. - Section 5 – Pending Criminal Charges
Report any current charges in any court. - Section 6 – Recent Employment Discipline (Last 3 Years)
Answer yes/no to firings, demotions, resignations under investigation, or probationary rejections. - Section 7 – Criminal History (Last 10 Years)
Disclose all convictions (felony or misdemeanor, excluding traffic). Provide full details on a separate sheet if “Yes.”
Conviction Details Required (if applicable):
- Date of offense
- Court and jurisdiction
- Disposition (fine, probation, jail/prison term, release date)
For every conviction: Attach a copy of the arresting agency report and a certified copy of the court documents.
- Certification & Signatures
- Sign under penalty of perjury
- Print name, title, date, and city
- Your employing business partner must also sign the acknowledgment
Pro tip: Initial the conviction notice box — failure to do so can cause denial.
How to Submit the REG 4019 Form?
Submit the completed, signed REG 4019 (plus any required attachments) as part of your BPA Program application package. The DMV’s Business Partner Automation Program page provides the full checklist.
Applications become null and void after 12 months if not completed.
Frequently Asked Questions (FAQ)
Q: Is the REG 4019 form free?
Yes – it is an official DMV PDF available at no cost.
Q: Can I fill it out online?
No. Download the PDF, print it, and complete it by hand or with Adobe Acrobat (then print and sign). Electronic signatures are not accepted.
Q: What if I have a conviction?
Disclose it fully. Listing a conviction does not automatically disqualify you, but failure to disclose does.
Q: How long does the screening take?
Processing times vary; the DMV may conduct additional background checks and interviews.
Q: Is my information private?
Certain personal information is exempt from public disclosure under the Information Practices Act of 1977 and the Public Records Act.
Final Tips for a Successful REG 4019 Submission
- Answer every question completely
- Use a separate sheet for any “Yes” explanations
- Attach all required court and arrest documents
- Double-check signatures and initials
- Keep a copy for your records
Direct Download Link (Official DMV):
REG 4019 Statement of Personal History Screening PDF
Ready to apply? Visit the official California DMV Business Partner Automation Program page for the complete application process and additional forms.
This article is based exclusively on current official California DMV sources and the REG 4019 form itself (as of April 2026). Always verify the latest requirements directly on dmv.ca.gov before submitting.