Application For Licensure - 1998 (Page 2 of 2) in pdf

Application For Licensure - 1998 Page 2

As part of the application process, the Department of Licensing conducts

background checks for criminal convictions on applicants.

Please provide one clear set of fingerprints with the application.

Certification - mandatory signature

I, _______________________________________________ , certify that the information provided in this application

Print applicant name (first, middle, last)

and any supporting documents, is true, complete, and correct to the best of my knowledge. I understand that should I

misrepresent or conceal any material fact(s) in my application for a private security guard license, it constitutes grounds

for denial or suspension of a license. I understand that the Department of Licensing may conduct a complete background

investigation regarding my application pursuant to Chapter 18.170 RCW.

_________________________________________

Signature of applicant

Date _________________________

Authorization - voluntary signature

I, _______________________________________________ , voluntarily authorize the Department of Licensing to

Print applicant name (first, middle, last)

release any and all criminal history information, including non-conviction information, so obtained to my employer, or to

my prospective employer.

_________________________________________

Signature of applicant

Date _________________________

PSG-690-008 U/A PRI. SEC. GD APP. (R/11/98)FM/W Page 2 of 2

Application For Licensure - 1998 Page 2