The application for a license to carry a concealed handgun shall be completed, under oath, on a form promulgated by the Director of the Division of Arkansas State Police and shall include only:
(1) The name, address, place and date of birth, race, and sex of the applicant;
(2) The driver's license number or Social Security number of the applicant;
(3) Any previous address of the applicant for the two (2) years preceding the date of the application;
(4) A statement that the applicant is in compliance with criteria contained within §§ 5-73-308(a) and 5-73-309;
(5) A statement that the applicant has been furnished a copy of this subchapter and is acquainted with the truth and understanding of this subchapter;
(6) A conspicuous warning that the application is executed under oath, and that a knowingly false answer to any question or the knowing submission of any false document by the applicant subjects the applicant to: Criminal prosecution and precludes any future license's being issued to the applicant; and
(7) Immediate revocation if the license has already been issued;
(8) A statement that the applicant desires a legal means to carry a concealed handgun to defend himself or herself;
(9) A statement of whether the applicant is applying for: An unrestricted license, that allows the person to carry any handgun; or
(10) A restricted license, that allows the person to carry any handgun other than a semiautomatic handgun.
(11) An applicant requesting an unrestricted license shall establish proficiency in the use of a semiautomatic handgun.
(12) An applicant requesting a restricted license shall establish proficiency in the use of a handgun and may use any kind of handgun when establishing proficiency; and
(13) A statement of whether or not the applicant has been found guilty of a crime of violence or domestic abuse.