It has come to our attention that there have been some changes to Form Psb 12. We would like to take this opportunity to inform you of these changes and what they may mean for you. Please bear in mind that we are still awaiting final confirmation on all of the details, so the information presented here is subject to change. Thank you for your understanding. The most significant change on Form Psb 12 is the addition of a new section requiring filers to declare their foreign income and assets. This new section will require extensive documentation, including bank statements, copies of foreign tax returns, and proof of ownership or inheritance for any foreign properties or investments. Failure to submit complete and accurate information may result in fines and other penalties. Other changes include a revised definition of "household members" which could affect who must file a return, and new questions about dependency exemptions and contributions to employer-provided health insurance
| Question | Answer |
|---|---|
| Form Name | Form Psb 12 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | PSB 12 texas private security deferred adjudication form |
Texas Department of Public Safety
Private Security Bureau
PO Box 15999, Austin, Texas
www.txdps.state.tx.us
APPLICATION FOR PERSONAL PROTECTION OFFICER (BODY GUARD) AUTHORIZATION
I am at least 21 years of age.
I am not addicted to drugs or alcohol, have never been arrested, charged, indicted, entered into a
I am mentally competent, and, if in the military, I was discharged under honorable conditions.
I will not carry a concealed firearm unless I apply for and receive a personal protection officer authorization from the Private Security Bureau.
Please complete and submit the following items: |
|
Qualifications: |
|
1. |
$50.00 Application Fee + $5.00 Subscription Fee= $55.00 |
1. Employed by a licensed guard or investigations company |
|
2. |
Level Four Personal Protection Officer Certificate of Completion |
2. |
Completed PSB Levels 2, 3 and 4 training courses |
3. |
Completed Declaration of Psychological and Emotional Health |
3. |
Currently have, or are applying for a security officer commission |
4. |
Current handgun proficiency certificate (within last 90 days) |
|
|
Note: Fee(s) submitted by mail, must also have a
Fees submitted to the Private Security Bureau are not refundable or transferable.
Employment Hours:( ) Full Time( ) Part Time
PLEASE TYPE OR PRINT CLEARLY
Company Name: ______________________________________________ Company License Number: _____________
Company Address: ____________________________________________________ Company Phone: ___________________
Number & Street |
City |
State |
Zip |
area code + number |
Social Security Number: ___________________________ |
|
TX Driver License or TX ID: _____________________ |
||
Name: __________________________________________________________________________________________________
LastFirstMI
Home Address: ________________________________________________________ Home Phone: _____________________
|
Number & Street |
City |
State |
Zip |
|
area code + number |
||
Date of Birth: __________________ |
Place of Birth: ______________________________________ |
|||||||
|
|
|
|
|
|
City/State or Country |
|
|
Sex (circle one): |
1. Male |
2. Female |
Height/Weight: |
Feet: ______ Inches: ______ Pounds: _________ |
||||
Eyes (circle one): |
1. |
Blue |
2. Brown |
3. Gray |
4. Hazel |
|
5. Green |
6. Black |
Hair (circle one): |
1. |
Black |
2. Red |
3. Gray |
4. Brown |
|
5. Blonde |
6. Bald |
Race (circle one): |
1. White |
2. Black |
3. Spanish |
4. Amer. Indian |
5. Asian |
6. Other________________ |
||
List any alias you have used: _______________________________________________________________________________
Applicant’s Signature:___________________________________________ Date:______________________
This section must be completed by the Qualified Manager or Owner
I hereby verify that the above applicant began employment in a position that requires registration with my company on:
__________________________________
Applicant’s Date of Employment
I am requesting that the above applicant be issued a personal protection authorization with my company as my employee.
Qualified Manager or Owner Signature: ___________________________________ Date: _________________
NOTICE: THIS IS A GOVERNMENTAL RECORD.
ANY FALSE ENTRY MADE ON THIS DOCUMENT COULD BE CONSIDERED A CRIMINAL VIOLATION.
Page 1 of 1 |
Rev. 10/12/09 |