Application For Bail Enforcement Agency License/private Investigative Agency License/private Security Agency License Page 2
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1
2
3BUSINESS NAMES
The applicant will use the following trade, business or advertising names(s):
Trade Name
County of Registration
State of Registration
___________________________________________________________________________________________________
___________________________________________________________________________________________________
The address(es) of this business
(
) is
(
) will be:
Address
Phone
_____________________________________________________________________________(_____)________________
_____________________________________________________________________________(_____)________________
BADGES, UNIFORMS, INSIGNIA, PATCHES AND HATS
If you are applying for a private security license, are you going to be using badges, uniforms, insignias, patches or hats for
your private security agency employees?
(If yes, provide photos of these items).
Yes
No
PERSONAL HISTORY
Name in full (last, first, middle)
List all other names you have used. Include nicknames, maiden name, and previous married surname(s).
Height
Weight
Hair
Eyes
Sex
Date of Birth
Drivers license number
Drivers license state of issue
List all other states in which you have had a drivers license issued to you:
Are you currently a peace officer, either part-time or full-time?
Yes
No
Have you ever been previously licensed in Iowa as a private investigative agency, private security agency, or a bail enforcement agency?
Yes
No
(If yes, when):
COURT RECORD
Have you ever been arrested or charged with any violation including traffic citations, but not parking tickets?
Yes
No
(List all such matters even if not formally charged, or no court appearance, or found not guilty, or matter settled by payment
of fine or forfeiture of collateral.)
Date
Place
Charge
Final Disposition
Details
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