Form Dps 366 C PDF Details

In an effort to streamline the process for those applying for positions that necessitate a great level of trust and responsibility, the Department of Emergency Services and Public Protection, Division of State Police, based at 1111 Country Club Road, Middletown, CT, has meticulously designed the DPS 366 C form. This form serves a crucial role for individuals and corporations aspiring to secure a license in private detective or security services. Diverse options are available under this licensing scheme, encompassing individual and corporate classifications, with further specializations such as private detective fire investigator and security service, just to hint at a few. Applicants are required to furnish detailed personal information, educational background, employment history, and a verifiable statement of citizenship, among other requisites. Notably, the form sets specific prerequisites for private investigator and security service applicants, ensuring only those with substantial experience or the requisite police background proceed. It also mandates a clean criminal and motor vehicle record, underscoring the high standards expected from applicants. Additionally, for military veterans, submission of documents like DD-214 or NGB-22 is vital to affirm discharge status. Prospective licensees must also submit a variety of supporting documents, including passport-style photographs, a full credit report, and letters of personal reference, thereby facilitating a comprehensive evaluation process. For corporate applicants, specific documentation related to their business structure is necessary. The DPS 366 C form underscores the commitment of the Department to uphold public safety and trust by ensuring that only qualified individuals and entities are granted the privilege to operate within these critical professions.

QuestionAnswer
Form NameForm Dps 366 C
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesLic, Servicse, reenlistment, LLC

Form Preview Example

DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION

DIVISION OF STATE POLICE

1111 Country Club Road Middletown, CT 06457-9294

Application for Private Detective or Security Service License

Check Type of License Desired:

Individual (including DBA)

Corporate (including LLC & Inc.)

Private Detective

Private Detective, Inc.

Private Detective Fire Investigator

Private Detective Fire Investigator, Inc.

Security Service

Security Service, Inc.

 

 

Applicant is:

Licensee

Corporate Official

Proprietary Licensee

Personal information:

Name of Applicant

 

 

Social Security #:

 

 

 

 

 

 

 

 

 

 

 

Date of Birth

 

Place of Birth

 

 

Height

 

Weight

Sex

 

 

 

 

 

 

 

 

 

Hair Color

 

Eye Color

 

Scars/Marks/Tattoos

 

Race

 

 

 

 

 

 

 

 

Firearms Permit No./State

 

 

Driver's License No./State

 

 

 

 

 

 

 

 

 

Home phone

 

 

 

 

Business phone

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

Prior home addresses for past five years: (use additional paper if needed)

 

 

From

To

Street/City/Town/State/Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employment history – Begin with present or most current and work backwards, Include dates of employment, duties/responsibilities, reason

for leaving employment. (Use additional paper if needed or attach resume)

Statement of Citizenship: (attach proof of citizenship)

Are you a citizen of the United States? Yes No

If naturalized, detail when and where:

Have you ever used any other name(s)? If so, list name(s) used: (Use additional paper if needed)

Are you currently vested with police powers?

Yes

No

1.

Education: (Indicate highest degree received (Attach copy of high school diploma/GED certificate or college transcript)

Degree/Diploma

High School

Associate Degree

Baccalaureate Degree

Masters/Doctorate Degree

Other _______________

Year Degree Awarded:

Name of College/University

List any schools or courses, which you believe qualifies you for the type of license applied for:

(The Commissioner of Emergency Servicse and Public Protection may, at his discretion, substitute up to one year of experience upon proof of satisfactory participation in a course of instruction pertinent to the license applied for. Include copies of training certificates. (Attach additional sheets of paper as required).

Private Investigator Applicants: Does the applicant meet the minimum five years of full time investigative experience or ten years of experience as a police officer with a state or organized

municipal police department? Yes No If "No " Explain: (Submit qualifying documentation) (Please reference CGS 29-154a)

Security Applicants: Does the applicant meet the minimum five years supervisory experience under a licensed security agency or ten years as a police officer with a state or organized municipal police department? Yes No If "No " Explain: (Submit qualifying documentation)

(Please reference CGS 29-161h)

Criminal and Motor Vehicle Record:

 

 

 

Have you ever been arrested for a criminal offense?

Yes

No

If Yes, explain:

 

 

 

 

 

Date/Place

Jurisdiction/Court

 

 

Charge

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been arrested on a motor vehicle charge?

Yes

No If Yes, explain:

Date/Place

Jurisdiction/Court

Charge

DPS-366-C (Revised 3/12)

PAGE 2

AN Affirmative Action/Equal Opportunity Employer

Military Service:

Yes

No

( If "Yes" DD-214 or NGB-22 must be attached)

Military branch or component

Highest Rank Attained

Type of Discharge

Business Information:

Proposed Trade Name*

Address of Home Office

 

 

Type Organization

Date & Place of Incorporation (attach Certificate of Incorporation or

 

 

Trade Certificate)

Individual

Corporate

 

 

 

 

Connecticut Addresses

Branch Manager’s Name:& D.O.B.

Telephone Numbers

_______________________

_______________________

_______________________

________________________

*Subject to approval by the Commissioner of Emergency Services and Public Protection.

Names, addresses, dates of birth, and proposed titles of all corporate officials: (use additional paper if necessary)

Are you currently licensed as a private investigator/security service in any other state?

 

Yes

No

If "Yes," Explain:

 

 

 

 

 

 

 

 

 

State

Lic. Number

Type of License

Date License Expires

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DPS-366-C (Revised 3/12)

PAGE 3

AN Affirmative Action/Equal Opportunity Employer

You must submit the following items with this application. (Use check boxes to indicate items are attached.

Incomplete packages will be returned)

Two photographs (2" x 2" passport style)

DD-214 or NGB-22, military discharge documentation

 

which includes type of discharge and reenlistment codes

Verification from State Agency

High school diploma/ GED cert., college transcript

 

or other proof of training

Documentation of employment

Full credit bureau report; summary not accepted

Copy of Motor Vehicle Driver’s License

Trade name, LLC or Incorporation papers.

Two fingerprint cards - 1 green (state card) with $50.00 payable to Treasurer, State of Connecticut, and 1 blue (FBI card) with $16.50 payable to the Treasurer, State of Connecticut. Submit prints with bank or postal money order only. NO CASH.

Motor vehicle abstract for LICENSEE only, for the past three years. Obtain the abstract from the motor vehicle licensing agency in the state of the licensee's residence for the past three years.

Also required are four letters of personal reference, LICENSEE ONLY. These letters of reference must be original letters and must be sent directly from the author to the Special Licensing & Firearms Unit. FORM LETTERS ARE NOT ACCEPTABLE AND WILL BE RETURNED.

Corporate Applicants: Submit this application( DPS-366-C) along with:

Two fingerprint cards - 1 green (state card) with $50.00 payable to Treasurer, State of Connecticut and 1 blue (FBI card) with $16.50 payable to the Treasurer, State of Connecticut. Submit prints with bank or postal money order only. NO CASH.

Two photographs (approximately 2" x 2" passport style)

Proprietary Applicants:

Submit only the DPS-366-C – NO FEES OR ADDITIONAL DOCUMENTATION REQUIRED.

Applications must be complete.

Authorization for Release of Personal Information

All of the information on this application must be verifiable or it will not be considered for licensing. False, misleading or omitted information may be the basis for denial of a license. "Any person who violates any provision shall be fined not more than $5,000.00 or imprisoned for not more than one year or both."

 

 

 

___________________________________

 

 

 

(Signature of Applicant)

STATE OF

 

 

 

SS

___________________________________

 

 

 

Date of Oath

COUNTY OF:

 

 

PERSONALLY APPEARED: _________________

ADDRESS:

Signer of the foregoing application and made oath of truth of matters contained before me.

Notary Public, Justice of Peace or Commissioner of Superior Court

My Commission Expires:

DPS-366-C (Revised 3/12)

PAGE 4

AN Affirmative Action/Equal Opportunity Employer