The Illinois perc card form is a document that allows you to apply for a fishing permit in the state of Illinois. The form is simple to fill out and only takes a few minutes to complete. You can download the form from the DNR website, or pick one up at your local license vendor. Make sure you have all the required information ready before you start filling out the form, including your name, address, contact information, and dates of birth for everyone applying for a permit. Once you have filled out the form completely, submit it to the DNR along with your payment. Your fishing permit will be mailed to you within 10 business days.
You may find details about the type of form you need to fill out in the table. It will tell you how much time you will require to complete illinois perc card, what parts you need to fill in and several further specific facts.
Question | Answer |
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Form Name | Illinois Perc Card |
Form Length | 5 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 1 min 15 sec |
Other names | illinois perc card application, illinois perc card application form, idfpr perc card application, perc card application |
INSTRUCTIONS FOR MAKING APPLICATION FOR A
PERMANENT EMPLOYEE REGISTRATION CARD (PERC)
NOTICE: ThePERCshallexpireonMay31,2012andevery3yearsthereafter.Youwillautomaticallyreceive yourrenewalapplicationinthemailapproximately90dayspriortotheexpirationdateofyourPERC. If you possess a valid Illinois detective, security contractor, alarm contractor, or locksmith license, then a PERC is not required to work for a licensed agency.
Before completing the application package, read each of the steps below and follow them as they apply to you. This will aid you in accurately completing your application and eliminate any delay in processing. The application which you submit is valid for three years from the date of receipt.
EXEMPTIONS: A peace officer as defined in the Private Detective, Private Alarm, Private Security, Fingerprint Vendor and Locksmith Act is exempt from the requirements relating to the possession of a permanent employee registration card (PERC). The employing agency shall remain responsible for any peace officer employed under this exemption.
Apersonemployedasanunarmedsecurityguardatanuclearenergy,storage,weapons,ordevelopmentsiteorfacilityregulated by the Nuclear Regulatory Commission who has completed the background screening and training mandated by the rules and regulations of the Nuclear Regulatory Commission is exempt from registration for a Permanent Employee Registration Card.
NOTE: |
If you have been issued a Permanent Employee Registration Card in the past, you may not apply for an |
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additionalcard. |
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a renewal application. Please indicate any change of address on your renewal application. |
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If your PERC has been lost, a written request for a reprint of your card and a $20.00 reprint fee must be sent to the |
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address in #7 below. |
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If you have applied for a Permanent Employee Registration Card within the past 3 years but did not complete the |
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applicationprocess,DO NOT submitanotherapplication. |
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request the status of your application. |
APPLICATION INSTRUCTIONS
1.Complete the application in its entirety. An incomplete or illegible application will be returned.
2.Applicant must be at least 18 years of age to apply for a PERC in an unarmed capacity.
3.Disclosure of your U.S. social security number, if you have one, is mandatory, in accordance with 5 Illinois Compiled Statutes
4.Submit a
5.Submit the appropriate security clearance documents (See Security Clearance below).
6.Attach one photograph to the application in the space provided.
7.Forward application (with photo attached), copy of the electronic fingerprint receipt, and fee payment to:
Illinois Department of Financial and Professional Regulation
ATTN: Division of Professional Regulation
P.O. Box 7007
Springfield, Illinois 62791
SECURITYCLEARANCE
Permanent Employee Registration Cards will not be issued until security clearance is completed. Reference the page entitled Important Notice / Criminal Background Check Information for details on fingerprinting.
The security clearance requirement is waived for those applicants who submit supporting document
Additional application forms can be downloaded from the IDFPR Web site at www.idfpr.com.
Packet updated 3/13/14 |
IMPORTANT NOTICE
CRIMINAL BACKGROUND CHECK INFORMATION
Individuals applying for licensure for professions that require fingerprints must submit to a criminal background check and provide evidence of fingerprint processing from the Illinois State Police (ISP), or a fingerprint vendor licensed by the Department. Fingerprints must be taken within 60 days from the date that the application is submitted to the Department or the Department’s testing vendor.
Certifying Statement of Fingerprint Submission Form (FP), or a receipt issued by a licensed fingerprint vendor must be submitted with the application and fee. The receipt shall be issued by the vendor at the time that fingerprints are obtained.
Applicants may contact a licensed fingerprint vendor to schedule an appointment for fingerprinting by goingto https://www.idfpr.com/LicenseLookUp/fingerprintlist.asp.TheISPwilltransmitelectronic results of fingerprint processing to the Department.
Illinois State Police
Bureau of Identification
260 North Chicago Street
Joliet, Illinois
For fingerprint processing fees, please contact ISP at
or at the following email address: BOI_Customer_Support@isp.state.il.us
PRIVACY STATEMENT
I understand by submitting fingerprints to the Department of Financial and Professional Regulation, Division of Professional Regulation any criminal history information may be shared, and I authorize the release of any information that may exist regarding me from any agency, organization, institution, or entity having such information on file. I am aware and understand that my fingerprints may be retained and will be used to check the criminal history record information files of the Illinois State Police and/or the Federal BureauofInvestigation.IfurtherunderstandthatIhavetherighttochallengeanyinformation disseminated from these criminal justice agencies regarding me that may be inaccurate or incomplete pursuant to Title 28 Code of Federal Regulation 16.34 and Chapter 20 ILCS 2630/7 of the Criminal IdentificationAct.
If you possess a valid Illinois Detective, Security Contractor, Alarm Contractor or Locksmith license, then a PERC is NOT required to work for a licensed agency.
APPLICATION FOR PERMANENT EMPLOYEE
REGISTRATION CARD
IMPORTANTNOTICE:
FOR OFFICIAL USE ONLY
1. NAME (Last Name, First Name, Middle Initial)
2.UNITEDSTATESSOCIALSECURITYNUMBER: (See Box # 17 Below.)
3. HOME STREET ADDRESS (No P.O. Boxes)
4.CITY
5.STATE
6.ZIPCODE
7.COUNTY
8.
10. AGE (18 yrs min.) 11. TELEPHONENUMBER
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(__ __ ___ ) ___ ___ ___ — ___ ___ ___ ___ |
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12. Have you ever been licensed as |
Private Detective, Private Security Contractor, Private Alarm Contractor, or Locksmith in Illinois or |
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another State? |
Yes |
No If yes, complete the following. |
List state(s) in which you have ever been licensed.
License Number
Dates of Licensure
From |
To |
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Is license current?
Has license ever been revoked, or
otherwise disciplined?
13.Have you been convicted of or pled guilty or nolo contendere to any criminal offense in any state or in federal court? Please do not give details on minor traffic charges, but do include information relating to Driving While Intoxicated (DWI) charges. If yes, attach a certified copy of the court records regarding your conviction, the nature of the offense and date of discharge, if applicable, as well as
a statement from the probation or parole office. |
Yes |
No |
14. Have you ever been dishonorably discharged from the armed services or from a city, county, state, |
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or federal position? If yes, attach explanation. |
Yes |
No |
15. Do you suffer from habitual drunkenness or from narcotic addiction or dependence? If yes, attach explanation. |
Yes |
No |
16.Have you ever been declared by any court incompetent by reason of mental or physical defect or
disease? If yes, attach explanation. |
Yes No |
17.In accordance with 5 Illinois Compiled Statutes
Are you more than 30 days delinquent in complying with a child support order? |
Yes No |
(NOTE: If you are not subject to a child support order, answer "no.")
18.In accordance with 20 Illinois Compiled Statutes
Are you in default on an educational loan or scholarship provided/ |
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guaranteed by the Illinois Student Assistance Commission or other |
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governmental agency of this State? |
Yes No |
I hereby certify that I personally completed this application, that the answers appearing hereon are true and correct to the best of my knowledge and belief and that I am legally authorized to sign this application.
Signature (in |
Date |
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I UNDERSTAND THAT FEES ARE NOT REFUNDABLE. My signature above authorizes the Department of Financial and Professional Regulation to reduce the amount of this check if the amount submitted is not correct. I understand this will be done only if the amount submitted is greater than the required fee hereunder, but in no event shall such reduction be made in an amount greater than $50.
ATTACH RECENT
PHOTOGRAPH HERE.
DO NOT STAPLE
USE TRANSPARENT TAPE ONALLSIDESOFPHOTO
RETURNTO: ILLINOISDEPARTMENTOFFINANCIALANDPROFESSIONALREGULATION
ATTN: DIVISIONOFPROFESSIONALREGULATION,P.O.BOX7007,SPRINGFIELD,ILLINOIS 62791
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IMPORTANT NOTICE: Completion of this form |
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EMPLOYEE NUMBER |
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is necessary to accomplish the requirements |
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EMPLOYEE'S STATEMENT |
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outlined in 225 ILCS 446/1 et. seq. (Illinois |
To be retained in employee's personnel file by the |
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CompiledStatutes). Disclosureofthisinformation |
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OF EMPLOYMENT |
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employing agency. |
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isREQUIRED. Failuretoprovideanyinformation |
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will result in this form not being processed. |
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NAME AND ADDRESS OF EMPLOYING AGENCY |
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NAME OF EMPLOYEE |
SOCIAL SECURITY NUMBER |
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ADDRESS OF EMPLOYEE (Include Street, City, State, and ZIP Code) |
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DATE OF BIRTH (Month/Day/Year) |
PLACE OF BIRTH |
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Have you ever been dishonorably discharged from the armed services? |
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Have you ever been convicted of ANY criminal offense, including a misdemeanor or a felony? |
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If yes, include a detailed explanation of the nature of the offense and the final disposition of the case. |
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Have you been declared by any court incompetent by reason of mental or physical defect or disease? |
Yes |
No |
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If yes, please explain. |
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Have you suffered from habitual drunkenness or from narcotic addiction or dependence? |
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Yes |
No |
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If yes, please explain. |
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Have you ever had a certificate denied, suspended or revoked under the Illinois Private Detective, |
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Private Alarm, and Private Security, and Locksmith Act? |
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Yes |
No |
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Please state business or occupation engaged in for the five (5) years immediately preceding the date of execution of this |
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statement, the location of such business or occupation, and the names of employers, if any. |
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Date: |
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Signature of Employee: |
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IMPORTANT NOTICE: Completion of this form is necessary for consideration for licensure under 225 ILCS 446/1 et.seq. of (Illinois Compiled Statutes). Disclosure of this information is VOLUNTARY. However, failure to comply may result in this form not being processed.
CERTIFYING STATEMENT OF FINGERPRINT SUBMISSION
SUPPORTING DOCUMENT
APPLICANT: This form must be completed by
1. NAME |
LAST |
FIRST |
MIDDLE |
2. DATE OF BIRTH |
3. SOCIAL SECURITY NUMBER |
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Month |
Day |
Year |
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4. ADDRESS STREET, CITY, STATE, ZIP CODE |
5. Three digit profession code and profession name (Check one.) |
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129 - Permanent Employee Registration |
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115 - Private Detective |
6. MAIDEN OR GIVEN SURNAME |
119 - Private Security Contractor |
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124 - Private Alarm Contractor |
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191 - Locksmith |
CERTIFYING STATEMENT
Under penalties of perjury, I declare that I, ___________________________________, have submitted
the required fingerprints pursuant to the Private Detective, Private Alarm, Private Security, Fingerprint Vendor, and Locksmith Act and the Rules for the Administration of the Act to the designated agent of the Illinois State Police for processing.
Date: ____________________________________ |
Signature: ___________________________ |