DPS 366 C is a new form that has been released by the Texas Department of Public Safety. The form is designed to collect data about hate crimes in the state. It is hoped that the information collected will help public safety officials to identify and address hate crimes more effectively. The form can be used by any individual or organization who believes they have been the victim of a hate crime. Anyone who experiences or witnesses a hate crime is urged to report it using DPS 366 C.
| Question | Answer |
|---|---|
| Form Name | Form Dps 366 C |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | Lic, Servicse, reenlistment, LLC |
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
DIVISION OF STATE POLICE
1111 Country Club Road Middletown, CT
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
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
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
PAGE 2 |
AN Affirmative Action/Equal Opportunity Employer
Military Service:
Yes
No |
( If "Yes" |
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 |
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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) |
|
|
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(
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
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:
PAGE 4 |
AN Affirmative Action/Equal Opportunity Employer