Form Pi-689-014 Armed Pi App - Application For Licensure As An Armed Private Investigator 2000 Page 2

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As part of the application process, the Department of Licensing conducts
background checks for criminal convictions on applicants.
Please provide two clear fingerprint cards with this application.
Certification
- Mandatory Signature
I,
, certify that the information provided in this application
Print Applicant's 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 18.165 RCW.
X
Date
Signature of Applicant
Authorization
- Voluntary Signature
I,
, voluntarily authorize the Department of Licensing to
Print Applicant's Name (First, Middle, Last)
release any and all criminal history information so obtained to my employer, or to my prospective employer.
X
Date
Signature of Applicant
UPON FILING, THIS APPLICATION BECOMES A PUBLIC RECORD AND IS
SUBJECT TO PUBLIC DISCLOSURE PROVISIONS PURSUANT TO RCW 42.17
PI-689-014 ARMED PI APP. (R/12/00)FM/W Page 2 of 2

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