Form Pi-689-01 - Unarmed Private Investigator Application For Licensure

Form Pi-689-01 - Unarmed Private Investigator 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

Please print name (first, middle, last )

provided in this application 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 investigator

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 applicant pursuant to Chapter 18.165 RCW .

___________________________________________________

__________________________________

Signature of applicant (first, middle, last )

Date

Authorization

voluntary signature

I, __________________________________________________________________, voluntarily authorize the

Please print name (first, middle, last )

Department of Licensing to release any and all criminal history information so obtained to my employer, or to my

prospective employer.

___________________________________________________

__________________________________

Signature of applicant (first, middle, last )

Date

The Department of Licensing has a policy of providing equal access to its services. If

you need special accommodation, please call (360)664-9072 or TTY (360)586-2788.

PI-689-012 UNARMED PI APP (R/6/98)M/W Page 2 of 2

Form Pi-689-01 - Unarmed Private Investigator Application For Licensure - 1998 Page 2