Form Dopl Ap 069 PDF Details

Navigating the requirements and protocols for becoming an Armored Car Security Officer in Utah is a structured process, initiated by the completion of the DOPL-AP-069 form. This document, issued by the Utah Division of Occupational and Professional Licensing (DOPL), is a critical step for candidates aspiring to enter the security personnel field, specifically focusing on armored car services. Applicants are required to provide comprehensive personal information, including legal names as per official identification documents, social security numbers, and details pertaining to citizenship or residency status. Additionally, the form necessitates disclosures regarding previous licensures, any criminal history, and a thorough affirmation of the applicant's eligibility and compliance with the statutes and regulations governing the practice in the state. Alongside this, the form contains sections for certification of having completed requisite training, both in basic classroom instruction and specialized firearms training, emphasizing the role's critical safety components. Through these measures, the form ensures that candidates are thoroughly vetted and qualified, safeguarding the integrity of the profession and the public's welfare. The DOPL-AP-069 not only serves as an application but also as a gatekeeper, ensuring that only those fully equipped with the necessary knowledge, skills, and legal eligibility can proceed towards licensing as Armored Car Security Officers in Utah.

QuestionAnswer
Form NameForm Dopl Ap 069
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other names108_armored_car _officer state of utah armored car license form

Form Preview Example

Issuing State:
License Status:
Issuing State:
License Status:

State of Utah

DIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING

160 East 300 South, P.O. Box 146741-Salt Lake City, Utah 84114-6741

Telephone (801) 530-6628

www.dopl.utah.gov

SECURITY PERSONNEL:

ARMORED CAR SECURITY OFFICER

***Please list your full legal name as it appears on your driver’s license, Social Security Card, etc.***

Last Name:

First Name:

 

Middle Name:

 

 

 

 

Social Security Number:

 

Maiden Name:

 

 

 

 

I certify under penalty of perjury that:

 

 

 

I am a citizen of the United States and I have a valid US Driver License or US State ID.

License/State ID Number: ________________

State: ________

I am a citizen of the United States currently living outside the United States and do not have a valid US Drivers License or US State ID. Attach a legible copy of your valid passport or other documentation to verify you are a legal citizen of the United States.

I am a non-citizen of the United States, who is lawfully present in the United States. I have a valid US Drivers License or US State ID. License/State ID Number: ________________ State: ________

I am a non-citizen of the United States, who is lawfully present in the United States and I do not have a valid US Drivers License or US State ID. Attach a legible copy of your current and valid government issued document showing evidence of authorization to work in the United States.

I am a foreign national not physically present in the United States.

Mailing Address:

City:

 

 

State:

ZIP:

 

 

 

 

 

Male

Phone #:

E-Mail:

 

Date of Birth:

 

Female

List all other licenses, registrations, or certifications issued by any state which you now hold or have ever held in any profession. (Use additional sheets if necessary.)

Profession:

License Number:

Issue Date:

 

 

Profession:

License Number:

Issue Date:

AFFIDAVIT and RELEASE AUTHORIZATION

1.I certify under penalty of perjury that I am a United States citizen or a qualified alien who is lawfully able to work in the United States.

2.I certify that I have read and understand all statutes and rules pertaining to my practice as an Armored Car Agent in Utah and I agree to comply with such.

3.I certify that am qualified in all respects for the license for which I am applying in this application.

4.I certify that to the best of my knowledge, the information contained in the application and its supporting document(s) is free of fraud, forgery, misrepresentation, omission of material fact; is truthful, correct, and complete; discloses all material facts regarding the applicant; and that I will update or correct the application as necessary, prior to any action on my application.

5.I authorize all persons, institutions, organization, schools, governmental agencies, employers, references, or any others not specifically included in the preceding characterization, which are set forth directly or by reference in this application, to release to the Division of Occupational and Professional Licensing, State of Utah, any files, records, or information of any type reasonably required for the Division of Occupational and Professional Licensing to properly evaluate my qualifications for licensure/certification/registration by the State of Utah.

Signature of Applicant: ________________________________________________ Date of Signature: ___ /___ /______ (mm-dd-yyyy)

DO NOT WRITE IN THIS SECTION - FOR DIVISION USE ONLY

Interim Permit # ___________________________________________

License/Certificate Number: _____________________________

Date License/Certificate Approved/Denied: ___/___/____

Temporary Approved/Denied By: _________________________

Approved/Denied By: __________________________________

Reason for Denial/Other Comments: _______________________

Application Complete

Qualifying Questionnaire

Copy of Drivers License / Valid ID

Training: Basic / Firearm

UCCH: Date: ______________

FBI/BCI Returned: Date: ______________

DOPL-AP-069 Rev 2013-08-22

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QUALIFYING QUESTIONNAIRE

 

 

 

 

Read thoroughly, and answer the questions. Do not leave any question blank.

 

 

 

 

(Note: If you have formally expunged a criminal record you do not need to disclose that criminal history.)

 

 

 

 

 

Yes

No

1.

Have you ever applied for or received a license, certificate, permit, or registration to practice in a regulated

 

 

 

 

profession under any name other than the name listed on this application?

Yes

No

2.

Have you ever been denied the right to sit for a licensure examination?

 

 

 

 

 

Yes

No

3.

Have you ever had a license, certificate, permit, or registration to practice a regulated profession denied,

 

 

 

 

conditioned, curtailed, limited, restricted, suspended, revoked, reprimanded, or disciplined in any way?

 

 

 

4.

Have you ever been permitted to resign or surrender your license, certificate, permit, or registration to practice in a

Yes

No

 

regulated profession while under investigation or while action was pending against you by any professional

 

 

 

 

licensing agency or criminal or administrative jurisdiction?

Yes

No

5.

Are you currently under investigation or is any disciplinary action pending against you now by any licensing

 

 

 

 

agency?

Yes

No

6.

Is any action pending against you now by either the Federal Drug Enforcement Administration or any state

 

 

 

 

enforcement agency?

Yes

No

7.

If you become licensed in the profession for which you are applying, would you pose a direct threat to yourself, to

 

 

 

 

your clients, or to the public health, safety, or welfare because of any circumstance or condition?

Yes

No

8.

Have you ever been declared by any court of competent jurisdiction incompetent by reason of mental defect or

 

 

 

 

disease and not restored?

Yes

No

9.

Have you ever had a documented case in which you were involved as the abuser in any incident of verbal,

 

 

 

 

physical, mental, or sexual abuse?

Yes

No

10.

Have you been terminated, suspended, reprimanded, sanctioned, or asked to leave voluntarily from a position

 

 

 

 

because of drug use or abuse within the past five (5) years?

 

 

 

11.

Are you currently using or have you recently (within 90 days) used any drugs (including recreational drugs) without a

Yes

No

 

valid prescription, the possession or distribution of which is unlawful under the Utah Controlled Substances Act or

 

 

 

 

other applicable state or federal law?

 

 

 

12.

Have you ever unlawfully used any drugs for which you have not successfully completed, or are not now

Yes

No

 

participating in a supervised drug rehabilitation program, or for which you have not otherwise been successfully

 

 

 

 

rehabilitated?

Yes

No

13.

Do you currently have any criminal action pending?

 

 

 

 

 

 

 

 

14.

Have you pled guilty to, no contest to, entered into a plea in abeyance or been convicted of a misdemeanor in any

Yes

No

 

jurisdiction within the past ten (10) years? Motor vehicle offenses such as driving while impaired or intoxicated

 

 

 

 

must be disclosed but minor traffic offenses such as parking or speeding violations need not be listed.

Yes

No

15.

Have you ever pled guilty to, no contest to, or been convicted of a felony in any jurisdiction?

Yes

No

16.

Have you, in the past ten (10) years, been allowed to plea guilty or no contest to any criminal charge that was later

 

 

 

 

dismissed (i.e. plea in abeyance or deferred sentence)?

Yes

No

17.

Have you ever been incarcerated for any reason in any correctional facility (domestic or foreign) in any jurisdiction

 

 

 

 

or on probation/parole in any jurisdiction?

 

 

 

If you answered “yes” to any of the above questions, enclose with this application complete information with respect to all circumstances and

 

 

 

the final result, if such has been reached. If you answered “yes” to Questions 13, 14, 15, 16, or 17 you must submit a complete narrative of

 

 

 

the circumstances that occurred for EACH and EVERY conviction, plea in abeyance, and/or deferred sentence. You must also attach copies

 

 

 

of all applicable police report(s), court record(s), and probation/parole officer report(s).

 

 

 

If you are unable to obtain any of the records required above, you must submit documentation on official letterhead from the police

 

 

 

department and/or court indicating that the information is no longer available.

 

 

 

If you have formally expunged a criminal record as evidenced by a court order signed by a judge, you do not need to disclose that criminal

 

 

 

 

 

 

history. Expungement orders must be sent to the Bureau of Criminal Identification and the FBI to enable the expungement to be completed

 

 

 

and the criminal history eliminated from the records.

 

 

 

A “yes” answer does not necessarily mean you will not be granted a license; however, DOPL may request additional documentation if the

 

 

 

information submitted is insufficient.

Printed Name of Applicant: ________________________________________________

Signature of Applicant: ________________________________________________ Date of Signature: ___ /___ /______ (mm-dd-yyyy)

DOPL-AP-069 Rev 2013-08-22

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Division of Occupational and Professional Licensing

160 East 300 South, P.O.Box 146741

Salt Lake City, Utah 84114-6741

FAX: (801) 530-6511

CERTIFICATION OF COMPLETING (24) HOURS OF BASIC CLASSROOM INSTRUCTION FOR ARMORED CAR

(This form must be completed for all armored car security officer applicants.)

TO BE COMPLETED BY APPLICANT:

Name of Applicant:

Social Security Number:

 

 

Phone:

Street Address:

 

 

 

 

 

 

 

City:

 

 

State:

 

 

Zip:

 

TO BE COMPLETED BY INSTRUCTOR OF (24) HOURS OF BASIC CLASSROOM INSTRUCTION:

I certify that the above named applicant has successfully completed at least 24 hours of basic classroom instruction consistent with Sections R156-63b-602, 603, and 604 of the Security Personnel Licensing Act Rules for Armored Car. In addition, I certify that the above named applicant achieved at least a minimum score of 80% on the basic education and training final exam in accordance with R156-63b-302d.

Name of Company/Individual Administering Training: (Please Print)

PACSCo ID, or License Number:

 

 

Phone Number:

Street Address:

 

 

 

 

 

 

 

City:

 

 

State:

 

Zip:

 

Basic Training Score on Final Exam:

Date Applicant Completed the Program: ___/___/___

Name of Program Trainer: (Please Print)

Signature of Program Trainer:

 

Date: ___/___/___

DOPL-AP-069 Rev 2013-08-22

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BLANK PAGE

(FOR TWO-SIDED PRINTING)

DOPL-AP-069 Rev 2013-08-22

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Division of Occupational and Professional Licensing

160 East 300 South, P.O.Box 146741

Salt Lake City, Utah 84114-6741

FAX: (801) 530-6511

CERTIFICATION OF COMPLETION OF FIREARMS

INSTRUCTION FOR ARMORED CAR

(This form must be completed for all armored car security officers applicants ONLY.)

TO BE COMPLETED BY APPLICANT:

Name of Applicant:

Social Security Number:

 

 

Phone:

Street Address:

 

 

 

 

 

 

 

City:

 

 

State:

 

 

Zip:

 

TO BE COMPLETED BY THE INSTRUCTOR OF THE FIREARMS TRAINING:

I certify that the above named applicant has successfully completed at least six (6) hours of classroom firearms instruction and at least six (6) hours of firearms instruction on the range consistent with Sections R156-63b-602 and 604 of the Security Personnel Licensing Act Rules for Armored Car. In addition, I certify that the above named applicant achieved at least a minimum score of 80% on the practical pistol course.

Name of Company/Individual Administering Training (Please Print):

PACSCo ID, or License Number:

 

 

Phone Number:

Street Address:

 

 

 

 

 

 

 

City:

 

 

State:

 

Zip:

 

Date Above Named Applicant Completed the Program:

Score on Practical Pistol Course:

Name of Program Trainer: (Please Print)

Signature of Program Trainer:

 

Date: ___/___/___

DOPL-AP-069 Rev 2013-08-22

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SECURITY PERSONEL APPLICATION

APPLICATION CHECKLIST

(This checklist is for your convenience—do not include it with your application)

Your application is classified as a public record and may be available for inspection by the public, except with regard to the release of information which is subclassified as controlled, private, or protected under the Government Records Access and Management Act or restricted by other law.

The following items are required for a full and complete application:

1.Submit a $100.00 non-refundable application-processing fee, made payable to “DOPL”. The fee is comprised of a $60.00 application fee, a $20.00 surcharge for a BCI fingerprint file search and a $20.00 surcharge for a FBI fingerprint file search.

2.Submit fingerprints to be used by DOPL for a fingerprint search through the files of the Utah Bureau of Criminal Identification (BCI) and the Federal Bureau of Investigations (FBI).

Electronic fingerprinting is offered to DOPL applicants, with no additional charge, at the DOPL office between 8:00 am and 4:30 pm, Mon-Friday, except holidays. A current government issued picture ID is required (driver’s license, state ID, passport, etc.).

If you are unable to obtain fingerprints at DOPL’s office, fingerprint services are available from most local law enforcement agencies. You are required to submit two (2) blue “Applicant” cards (Form FD-258) with your application; these cards will be provided by the agency that rolls your prints.

REVIEW OF YOUR FBI RECORD: If you wish to challenge the accuracy of the information in your FBI record, you should contact the agency that contributed the information in question. You may also direct the challenge to the FBI, Criminal Justice Information Services (CJIS) Division, Attn. SCU, Mod. D-2, 1000 Custer Hollow Road, Clarksburg, WV 26306. The FBI will forward the challenge to the respective agency.

3.Submit a clear and readable copy of a valid government issued driver's license issued by Washington D.C. or a state of the United States of America or Utah identification card.

4.Submit a “Certification of Completing 24 Hours of Basic Classroom Instruction” form documenting the successful completion of at least 24 hours of basic unarmed classroom instruction consistent with Sections R156-63a-602, and 603 of the Security Personnel Licensing Act Rules

5.Submit a “Certification of Completion of Firearms Instruction” form documenting the successful completion of at least six hours of classroom firearms instruction and at least six hours of firearms instruction on the range consistent with Sections R156-63a-602, and 604 of the Security Personnel Licensing Act rules.

6.Interim Permit Program: An Armed and Unarmed Private Security Officer may immediately start to work upon making application for a period of ninety (90) days if the individual’s criminal record in the state of Utah is clear at the time the individual applies for licensure and if the individual has been issued an Interim Permit Program form by DOPL.

To determine if the applicant’s criminal record in the state of Utah is clear at the time the individual applies for licensure, the applicant must submit with the application an official criminal history report, (Right of Access), from the Bureau of Criminal Identification showing "No Criminal Record Found."

NOTE: If the applicant applies for licensure and has any criminal history record or has marked “Yes” to any question on the Qualifying Questionnaire, an Interim Permit letter will not be issued. The application will be processed in the normal manner and if the application is approved, a temporary license will be issued.

Submit the above items, as well as any supporting documentation, to:

By U.S. Mail

 

 

By Delivery or Express Mail

Division of Occupational & Professional Licensing

Division of Occupational & Professional Licensing

P.O. Box 146741

 

 

160 East 300 South, 1st Floor Lobby

Salt Lake City, Utah 84114-6741

Salt Lake City, Utah 84111

Telephone Numbers:

(801)

530-6628

 

 

(866)

275-3675Toll-free in Utah

 

Fax Number:

(801)

530-6511

 

DOPL-AP-069 Rev 2013-08-22

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