Form Pi-689-01 - Unarmed Private Investigator Application For Licensure - 1998
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1
2STATE OF WASHINGTON
STATE OF WASHINGTON
Business and Professions Division
Department of
Department of
Unarmed Private Investigator
Private Investigator Licensing Program
Application for licensure
PO Box 9649
Olympia, WA 98507-9649
(360) 664-9072
New applicant $75.00
For validation only
Transfer/rehire $25.00 (plus renewal fee, if due)
Make checks payable to: State Treasurer
Please type or print clearly and sign on reverse
001-070-299-0013
Applicant information
Name (last, first, middle)
Date of birth
Aliases or maiden name (last, first, middle)
Residence address (number and street)
City
State
Zip
Home telephone
(
)
Sex
Social Security Number
U.S. Citizen
Resident alien
M
F
Business name
Business address (number and street)
City
State
Zip
County
Business telephone
Fax
(
)
(
)
Certification of preassignment training/testing
This is to certify that _______________________________________________________________________ has
Print applicant’s name
successfully completed the preassignment training and testing requirements as outlined in WAC 308-17-300. Incorrectly
answered questions were reviewed with the applicant and the test results have been verified and signed by me.
X
Signature of certified trainer
Printed name of certified trainer
/
/
Date
Legal profile
attach requested documents and a separate explanation sheet for “Yes” answers
Applicant - respond to all questions below. If you answer "yes" to any, attach a separate sheet with explanation.
Yes
No
Yes
No
1.
Have you ever been found guilty of divulging confidential
5.
Have you ever been convicted of any act involving
information obtained in the course of an investigation to
unethical or immoral behavior?
which you were assigned?
6.
Have you ever been convicted of a gross misdemeanor
2.
Have you ever been found guilty of making a material
or felony?
misstatement or omission in the application for or renewal
7.
Have you ever had a private investigator license
of a license or firearms certification?
suspended, revoked, or restricted? If "yes," in what
3.
Have you ever been found guilty of incompetence or
jurisdiction? (Please insert name of state, county, or city
negligence that resulted in injury to a person or created
___________________________________
an unreasonable risk that a person could have been
and date_____________________)
harmed?
8.
Have you ever held a private investigator license in any
4.
Have you ever been found guilty of accepting
other state or jurisdiction? If "yes," in what jurisdiction?
employment that was adverse to a client or former client
(Please insert name of state, county, or city
as it related to confidential information you obtained in
___________________________________
the course of your employment by the client?
and date_____________________)
If any conviction was dismissed, please enclose copies of the court documents.
sign on page 2
PI-689-012 UNARMED PI APP (R/6/98)M/W Page 1 of 2
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