Texas Form Psb 20 PDF Details

In the vast landscape of Texas's regulatory framework, the Texas PSB 20 form stands out as a crucial document for individuals seeking authority to operate within the private security sector. Mandated by the Texas Department of Public Safety Regulatory Services Division, this form is paramount for those applying for a Governmental Letter of Authority (GLOA) exemption, which includes roles such as non-commissioned security officers, commissioned security officers, and personal protection officers, whether they are filing an original application or seeking renewal. Detailed in its expectations, the form requires applicants to furnish comprehensive personal information like name, contact details, date, and place of birth, alongside specific physical characteristics. Moreover, it critically outlines the need for submitting fingerprints, either electronically or via fingerprint cards, with the accompanying fee, a step that underscores the commitment to ensuring the security officers' integrity and reliability. It further explores the applicant's background, inquiring about any past convictions, military discharge status, sex offender registration, citizenship status, and current legal standings, all aimed at meticulously vetting the applicant’s eligibility. The form also emphasizes the importance of truthful disclosures by highlighting the repercussions of failing to do so, thereby maintaining high standards within the industry. Finally, the inclusion of employer verification serves as an added layer of scrutiny, ensuring that only qualified individuals are granted the authority to perform security duties, thereby safeguarding the public's interest.

QuestionAnswer
Form NameTexas Form Psb 20
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesPSB 20 gloa texas dps private security form

Form Preview Example

Texas Department of Public Safety Regulatory Services Division

www.txdps.state.tx.us

• MUST USE MOST CURREN T

 

 

PRIVATE SECURITY

FORM

 

 

• KEY I N OR PRI N T CLEARLY I N BLACK I NK

EXAMPLE:

 

 

 

• MAKE SURE ENTI RE CI RCLE I S FI LLED

Yes

No

 

GOVERNMENTAL LETTER OF AUTHORITY (GLOA) EXEMPTION APPLICATION

REGI STRATI ON I NFORMATI ON

 

 

 

THE ABOVE SPACE I S RESERVED FOF OFFI CE USE ONLY

 

 

 

 

 

Type of Registration: (CHOOSE ONE)

Type of Application: (CHOOSE ONE)

 

Governmental Letter of Authority Non-Commissioned Security Officer

Original Application

 

Governmental Letter of Authority Commissioned Security Officer

Renewal Application

 

Governmental Letter of Authority Personal Protection Officer

 

 

 

 

 

 

 

 

 

 

APPLI CANT I NFORMATI ON

Gov Letter of

 

 

 

 

 

Gov Letter of Authority

Authority Name

 

 

 

 

 

License No.

 

 

 

 

 

 

 

 

Applicant Social

-

-

Driver License

DL/ I D

 

DL/ I D

Security Number

I D Card

State:

 

No.

 

 

 

 

 

 

 

 

 

 

Applicant Last Name

Home Address

First Name

Middle Name

Suffix

(I f Any)

City

State

 

ZI P

 

Home

(

)

 

 

(2- Digit Code)

 

 

Phone

 

 

 

 

 

 

 

 

Date of Birth

 

 

 

 

Place

(CI TY)

 

 

 

(STATE)

(COUNTRY)

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

(MM/ DD/ YYYY)

 

 

 

of Birth

 

 

 

 

 

 

 

 

 

 

Gender

Male

Female

Eyes

1.

Blue

2.

Brown

3.

Gray

4.

Hazel

5.

Green

6.

Black

Height

 

Ft.

I n.

Hair

1.

Black

2.

Red

3.

Gray

4.

Brown

5.

Blonde

6.

Bald

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Race

1.

 

2.

 

3.

 

4.

 

5.

 

6.

 

Weight

 

 

Lbs.

 

White

Black

Hispanic

American

Asian

Other

 

 

 

 

 

 

 

 

 

 

I ndian

 

 

_______

List any alias you have used:

Describe

Your Duties:

SUPPLEMENTAL I NFORMATI ON (REQUI RED WI TH ORI GI NAL APPLI CATI ON ONLY – DOES NOT APPLY TO RENEWALS)

Regarding submitting Fingerprints: (CHOOSE ONLY ONE)

I am submitting two (2) classifiable, Board approved fingerprint cards along with the $ 25 FBI classification fee.

I am submitting the $ 25 FBI classification fee. My fingerprints were submitted electronically and my signed I BT FAST receipt is attached as proof with this application.

I am a Peace Officer (or Retired Peace Officer) alternatively submitting a PSB-00 (Peace Officer Fingerprint Waiver) form with this application, instead of FBI fingerprint cards.

PAYMENT I NFORMATI ON

Original Registration Application Fee OR Renew al Fee: $0

I am submitting the appropriate fee(s) with this application by mail.

Yes

(Note: Payment must be in the form of a cashier’s check, money order or company check.)

No

* I f yes, a PSB-50 form m ust be submitted with this application.

I understand all fees submitted to Private Security are non- refundable and non transferable. I n accordance with Administrative Rule Yes

35.77, I have 90 days from the date the application is received by the Department to submit all required documentation, supplemental information and/ or fees or this application will be abandoned and I will be required to reapply.

No

PSB-20 (Rev. 06/ 2011)

Page 1 of 2

FORM

Applicant Name

Social

-

-

Security No.

BACKGROUND I NFORMATI ON – PART I ( ALL APPLI CANTS)

 

1.

Have you ever been convicted, in any jurisdiction, of a felony

Yes

* I f yes, has it been LESS than ten (10) years since

completing

your

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

level offense?

 

No

sent ence or probat ionary period?

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Have you ever been convicted, in any jurisdiction, of a Class A or

Yes

* I f yes, has it been LESS than five (5) years since completing your sent ence

 

Yes

 

 

 

 

 

 

 

equivalent misdemeanor?

 

No

or probat ionary period?

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Have you, within the past 5 years, been convicted, in any jurisdiction, of a Class B misdemeanor or equivalent offense?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Are you currently charged with, or under indictment for, a felony, or Class A misdemeanor?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

Are you currently charged with a Class B misdemeanor?

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

Have you ever been found by a court to be incompetent by reason of mental defect?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

* I f yes, and

you

received a dishonorable discharge, a bad conduct discharge, or

an

other

than

 

 

7.

Were you discharged from the military?

honorable discharge, from Armed Forces, then you must submit a copy of your DD- 214 .

 

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

8.

Are you required to register as a sex offender, in the state of Texas or any other state?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

Federal law prohibits the Bureau from issuing a license to anyone

Yes

I f yes, you must submit documentation of your naturalization or a copy

 

 

 

 

who is ineligible to work in the U.S. Are you a non- citizen?

 

No

of your permanent resident card.

 

 

 

 

 

 

 

 

 

 

 

 

BACKGROUND I NFORMATI ON – PART I I ( COMMI SSI ONED SECURI TY OFFI CERS & PERSONAL PROTECTI ON OFFI CERS ONLY)

 

 

 

 

 

 

 

 

 

10.

Are you currently restricted under a court protective order or subject to a restraining or affecting the spousal relationship, other than a

 

Yes

 

 

 

 

 

 

 

restraining order solely affecting property interests, including any court order restraining your conduct as to an intimate partner?

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

Have you been diagnosed by a license physician as suffering from a psychiatric disorder or condition that causes or is likely to cause substantial

 

Yes

 

 

 

 

 

 

 

impairment in judgment, mood, perception, impulse control, or intellectual ability? (See Occupations Code §1702.163 (d), (e) & (f).)

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

Have you been convicted in any court of a misdemeanor offense involving domestic violence?

 

 

 

 

Yes

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

Are you an unlawful user of a controlled substance or addicted to any controlled substances?

 

 

 

 

Yes

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BACKGROUND I NFORMATI ON – PART I I I ( ALL APPLI CANTS)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

I understand that, any pending charges or conviction referred to in Background I nformation Parts I and I I above require the submission of the

 

Yes

 

 

 

 

 

 

 

appropriate court documentation, with this application. Failure to report an arrest or conviction, later found by a fingerprint search, may result

 

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

in denial or revocation of a license based solely on the material misstatement of fact in this application.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

I acknowledge that I have review ed the eligibility criteria of Occupations Code §1702.113 and the definition of ‘conviction’ provided in §1702.371

 

Yes

 

 

 

 

 

 

 

and Administrative Rule §35.1. I also acknowledge that I have review ed the disqualifying offenses listed in Administrative Rules 35.42 and 35.46.

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER I NFORMATI ON (TO BE COMPLETED BY QUALI FI ED MANAGER, MANAGER’S DESI GNEE OR OWNER)

I hereby certify that the above applicant began employment in a position that requires this registration with my company on:

Applicant’s Date of Employment (MM/ DD/ YYYY)

/

/

I am requesting that the above applicant be issued a registration with my company as my employee.

Manager or Manager’s Designee Printed Last Name

Printed First Name

I verify that the information provided is true and correct, and I understand that this is an official Government record and that any false statement made on this document or any other supplement provided to the Department may result in criminal prosecution.

Applicant Signature________________________________________________

Date____ / ____ / ________

Manager or Manager’s Designee Signature________________________________________________

Date____ / ____ / ________

This form and attachments can be forwarded by mail to:

 

Texas Department of Public Safety

Private Security MSC 02 42

PO Box 15999

Austin, TX 7 8761 - 5999

PSB-20 (Rev. 06/ 2011)

Page 2 of 2

FORM

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