Form Psb 38A – Fill Out and Use This PDF

Texas Department of Public Safety – Private Security Bureau

PO Box 15999, Austin, Texas 78761-5999

www.txdps.state.tx.us

ORIGINAL COMMISSION APPLICATION

Employment Hours:( ) Full Time( ) Part Time

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Please complete and submit the following items:	Original Fee:	Subscription Fee:	Total Cost:
( ) Commissioned Security Officer	$50.00	+ $5.00	= $55.00

Fee(s) submitted by mail, must also have a PSB-50 form attached.

By Mail: $25.00 FBI fingerprint fee and submit two classifiable & completed fingerprints on Bureau issued fingerprint cards.

By internet utilizing the Texasonline and IBT services: $25.00 FBI fingerprint fee and provide a copy of your signed IBT FAST Receipt.

Note: If you are a full-time Peace Officer, you are not required to submit FBI fingerprint cards; however you must submit form PSB-49 Peace Officer Fingerprint waiver along with your application.

Submit Level Two and Three Certificate of Completion.

Note: If you are a full-time Peace Officer certified by Texas Commission on Law Enforcement Officer Standards and Education (TCLEOSE) and employed at least 32 hours per week by a Texas Law Enforcement Agency you may submit form PSB-00 Peace Officer Training Certificate.

If applicable, please provide a copy of your certificate of naturalization or permanent resident alien card.

NOTE: Please check the appropriate boxes:
( ) Submitted FBI Fee $25.00	( ) Attached two fingerprint cards	( ) Attached copy of your signed IBT FAST receipt

( ) Attached PSB-49 Fingerprint Waiver

*********************************************Critical Infrastructure***************************************** Check this box if you are applying as a “Critical Infrastructure” facility. Complete PSB-44 (Critical Infrastructure) form and

submit this form along with the Original Registration Application. This form is located on our website at www.txdps.state.tx.us/psb.

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Fees submitted to the Board are not refundable or transferable.

PLEASE TYPE OR PRINT CLEARLY

Company Name: _______________________________________________	Company License Number: _____________________
Social Security Number: ____________________________	TX Driver License or TX ID: ____________________

Name: ____________________________________________________________________________________________________ _____

LastFirstMiddle

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: _______________________________________________________________________________________

Describe your Duties: _____________________________________________________________________________________________

COMPLETE THE REVERSE SIDE OF THIS FORM

PSB-38A

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Rev. 10/12/09

Texas Department of Public Safety – Private Security Bureau

PO Box 15999, Austin, Texas 78761-5999

www.txdps.state.tx.us

The Applicant must answer each question below before this application can be processed.

Explanations or qualifications may be added as an attachment.

Please place an “X” to mark your appropriate response and answer each question.

(1)	Have you ever been convicted, in any jurisdiction, of a felony level offense?		□ YES □ NO
(2)	If you answered YES to (1) above, has it been LESS than 10 years since you completed		□ YES □ NO □ NOT APPLICABLE
	your sentence or probationary period?		□ YES □ NO
(3)	Have you ever been convicted, in any jurisdiction, of a Class A or equivalent misdemeanor?
(4)	If you answered YES to (3) above, has it been LESS than 5 years since you completed your		□ YES □ NO □ NOT APPLICABLE
	sentence or probationary period?		□ YES □ NO
(5)	Have you, within the past 5 years, been convicted, in any jurisdiction, of a Class B
	misdemeanor or equivalent offense?		□ YES □ NO
(6)	Are you currently charged with, or under indictment for, a felony, or a Class A misdemeanor?
(7)	Are you currently charged with, a Class B misdemeanor?		□ YES □ NO
(8)	Have you ever been found by a court to be incompetent by reason of mental defect?		□ YES □ NO
(9)	Have you received a dishonorable discharge, a bad conduct discharge, or an other than		□ YES □ NO
	honorable discharge, from the Armed Forces?	(If yes attach a copy of your DD-214).	□ YES □ NO
(10) Are you required to register as a sex offender, in this state or any other state?
(11) Are you currently restricted under a court protective order or subject to a restraining order affecting			□ YES □ NO
	the spousal relationship, other than a restraining order solely affecting property interests, including
	any court order restraining your conduct as to an intimate partner?		□ YES □ NO
(12) Have you been diagnosed by a licensed physician as suffering from a psychiatric disorder or condition

WARNINGS: Any pending charges or convictions referred to above require the submission of the appropriate court documentation, with this application. Failure to report an arrest or conviction later found by a fingerprint search may result in denial of or revocation of a license based solely on the material misstatement of fact in this application.

By signing below, you are acknowledging that you have reviewed the eligibility criteria of Occupations Code §1702.113 and the definition of „conviction‟ provided in §1702.371 and Administrative Rule §35.1. In addition, you have acknowledged and reviewed the disqualifying offenses listed in Administrative Rule 35.46.

I acknowledge that I have read and understand the information contained in the above warning paragraph, and that I have truthfully answered all of the above questions. I understand that a false entry on this document could be considered a criminal violation.

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 registration 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.

In accordance with Rule 35.77, any applications considered incomplete after 90 days may be voided and a new application along with all

appropriate documentation and fees may be required.

PSB-38A

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Rev. 10/12/09