SECTION IV             ALIAS INFORMATION

If you are known by any other name, be sure to include it in this section. This includes nicknames, married names, maiden names, a legal name change, alias names, fictitious names, etc.

SECTION V              PERSONAL HISTORY

1. If you have ever been adjudicated incapacitated (determined by the court to be incapable of taking care of yourself), you must provide a copy of the court document restoring your capacity.
2. If you have ever been involuntarily placed in a treatment facility for the mentally ill under Chapter 394, F. S., or similar laws of another state, you must provide a copy of the court document restoring your competency.
3. If you have ever been diagnosed with a mental illness, you must provide a statement from a psychologist or psychiatrist licensed in Florida attesting that you are not currently suffering from a mental illness that precludes you from performing the duties of an unarmed security officer.
4. If you are currently abusing a controlled substance, you are not eligible for licensure.
5. If you have a history of controlled substance abuse, you must provide evidence of successful completion of a substance abuse rehabilitation program and three letters of reference, one of which should be from your sponsorin the program.
6. If you have a history of alcohol abuse, you must provide evidence of successful completion of an alcohol rehabilitation program and three letters of reference, one of which should be from your sponsor in the program.

SECTION VI            TRAINING/EXPERIENCE

You must submit proof of successful completion of a minimum of 40 hours of professional training provided by a Security Officer School or Training Facility licensed by the Department of Agriculture and Consumer Services.

Exceptions:

1. If you are a currently employed law enforcement officer, correctional officer or correctional probation officer certified by FDLE Criminal Justice Standards & Training Commission, a copy of your valid ID card issued by your employing law enforcement agency is sufficient to satisfy the training requirement.
2. If you have successfully completed a training program approved by the Florida Criminal Justice Standards and Training Commission for certification as a law enforcement officer, correctional officer or correctional probation officer, a copy of your certificate of completion is sufficient to satisfy the training requirement.
3. If you qualify for a Class “DI” Security Officer Instructor license under Rule 5N-1.138(1)(e)-(g), Florida Administrative Code, proof of such qualification is sufficient to satisfy the training requirement.
4. Relevant military training or education received and completed during service in the United States Armed Forces.

SECTION VII            CERTIFICATION OF QUALIFIED EXEMPTION FROM PUBLIC RECORDS DISCLOSURE

Section 119.071, F.S., excludes from public disclosure specified information such as home addresses, telephone numbers, Social Security numbers, and photographs pertaining to certain individuals. To determine whether you qualify for an exemption, read the complete text of the law on line at http://www.leg.state.fl.us/Statutes/. IF YOU QUALIFY FOR EXEMPTION, answer this question to specify whether you want the statutorily exempt information to be kept from public disclosure. If you do NOT qualify for the exemption, leave it blank

SECTION VIII           CITIZENSHIP

If you are not a U.S. Citizen, you must submit proof of current employment authorization issued by the Department of Homeland Security, U.S. Citizenship and Immigration Services (USCIS). A COPY of the front and back of one of the following USCIS forms is sufficient: I-551, I-766.

SECTION IX          PERSONAL INQUIRY WAIVER AND NOTARIZATION STATEMENT

Do not sign the application until you are in the presence of the Notary Public who will notarize your application

GENERAL INFORMATION

• A Class “D” licensee must own or work for a Class “B” Security Agency or Class “BB” or “AB” Branch Office. This does not include a person who is exempt under Section 493.6102, Florida Statutes, but who possesses a Class “D” license solely for the purpose of holding a Class “G” license as an armed proprietary security officer.
• You may begin work as unarmed security officer upon submission of your complete application. If your application is deemed incomplete, a Notice of Errors or Omissions will be sent to you and to your employer. Your employment must be terminated until the problems outlined in the letter are resolved.
• An applicant or licensee is ineligible to reapply for the same class of license for a minimum period of one year following final agency action of denial or revocation of a license. However, this time restriction shall not apply to administrative denials where the basis was either of the following:

1. 1. An inadvertent error or omission on the application or failure to submit required fees; or,
   2. The Department was unable to complete the criminal background investigation due to insufficient information
      from the Department of Law Enforcement, the Federal Bureau of Investigation, or any other applicable law
      enforcement agency.

Submit your application to the Department of Agriculture and Consumer Services, Division of Licensing, Regional Office nearest you - or mail it to the Department of Agriculture and Consumer Services, Division of Licensing, Post Office Box 5767, Tallahassee, Florida 32314-5767.

License Fee:* $45
Fingerprint Processing Fee:** $42
Fingerprint Retention Fee** $10.75
TOTAL FEES REQUIRED $97.75

*The initial license fee for a veteran, as defined in s. 1.01, shall be waived if he or she applies for a license within 24 months after being discharged from any branch of the United States Armed Forces. An eligible veteran must include a
copy of his or her DD Form 214, as issued by the United States Department of Defense, or another acceptable form of identification as specified by the Department of Veterans’ Affairs with his or her application in order to obtain a waiver.
**If you are also submitting an application for another class of license under Chapter 493, F.S., at this time, submit only one set of fingerprints and a single fingerprint-processing and retention fee. If you have submitted a set of fingerprints and a fingerprint-processing and retention fee for a license under Chapter 493 within the past six months, no fingerprint submission or fingerprint-processing or retention fee is necessary at this time.

PHOTOGRAPH SPECIFICATIONS

• Your photograph must be:
• ¾ In color, non-retouched.
• ¾ Printed on matte or glossy photo quality paper.
• ¾ 2 x 2 inches (51 x 51 mm) in size.
• ¾ Sized such that the head is between 1 inch and 1 3/8 inches (between 25 and 35 mm)
• from the bottom of the chin to the top of the head.
• ¾ Taken within the last 6 months to reflect your current appearance.
• ¾ Taken in front of a plain white or off-white background.
• ¾ Taken in full-face view directly facing the camera.
• ¾ With a neutral facial expression and both eyes open.
• Taken in clothing that you normally wear daily:

1. 1.  Uniforms, clothing that looks like a uniform, and camouflage attire should not be worn in photos except in the case of religious attire that is worn daily.
   2. You may only wear a hat or head covering if you wear it daily for religious purposes. Your full face must be visible and your head covering cannot obscure your hairline or cast shadows on your face.
   3. Headphones, wireless hands-free devices or similar items are not acceptable in your photo.
   4. If you normally wear prescription glasses, a hearing device or similar articles, they may be worn for your photo. Glare on glasses is not acceptable in your photo.
   5. Dark glasses or non-prescription glasses with tinted lenses are not acceptable unless you need them for medical reasons (a medical certificate may be required).

FINGERPRINT SUBMISSION INSTRUCTIONS

You must submit a complete and legible set of fingerprints either on the FINGERPRINT CARD enclosed with this application package or
by ELECTRONIC FINGERPRINT-SCAN. Your fingerprints can be taken at a participating law enforcement agency, by your employer, or
by any business providing fingerprinting services.

FOR INFORMATION REGARDING ELECTRONIC FINGERPRINT-SCAN, visit our web page http://mylicensesite.com.

IF SUBMITTING YOUR PRINTS ON THE ENCLOSED CARD, read and follow these instructions carefully:

Fingers should be washed and dried thoroughly prior to prints being taken.

• Fingerprints must be rolled using black printer’s ink.
• The information you provide on the card MUST BE TYPED or PRINTED IN BLACK INK. However, please note that some spaces at the top of the fingerprint card should be left blank.
• DO NOT SIGN the fingerprint card until you are in the presence of the person who will take your fingerprints. Your signature and the name on your application and fingerprint card should match.

1. 1. NAM – Full name in following order LAST, FIRST, MIDDLE. Initials are not acceptable. If you have no middle name, enter NMN for MIDDLE.
   2. RESIDENCE OF PERSON FINGERPRINTED – Your RESIDENCE address.
   3. MPLOYER AND ADDRESS – If you are currently employed, provide the name of your employer.
   4. ALIASES AKA – If you are known, or have been known, by any other name (nickname, married name, maiden name, alias, fictitious name, etc.), list those name(s) here. Include with your application copies of any legal documents that reflect a change of name (marriage certificates, divorce decrees, court affidavits effecting a legal name change, etc.). NOTE: Failure to provide a list of your other names or to furnish documentation pertaining to a legal name change will result in delays in the processing of your application.
   5. CITIZENSHIP CTZ – Enter the country of which you are a citizen (U.S., Cuba, Canada, etc.)
   6. ARMED FORCES NO. MNU – Enter your military service number if you have one.
   7. SOCIAL SECURITY NO. SOC – Sections 493.6105, 493.6304, and 493.6406, Florida Statutes, in conjunction with section 119.071(5)(a) 2, Florida Statutes, mandates that the Department of Agriculture and Consumer Services, Division of Licensing obtain social security numbers from applicants. Applicant social security numbers are maintained and used by the Division of Licensing for identification purposes, to prevent misidentification, and to facilitate the approval process by the Division.
   8. HGT (height) – Use feet and inches (example: for 5’11” enter 511)
   9. DATE OF BIRTH DOB (mmddyy); PLACE OF BIRTH POB, WGT (weight) – Enter required information.
   10. You are not required to complete YOUR NO. OCA or FBI NO. FBI or MISCELLANEOUS NO. MNU.
   11. SEX, RACE, EYES, and HAIR - FBI codes are shown below. Use appropriate code for each required area on the card.

SEX RACE EYE COLOR HAIR COLOR
M = Male
F = Female
W = White A = Asian or Oriental
B = Black U = Other or Unknown
I = American Indian
or Alaskan Native
BLK = Black GRY = Gray
BLU = Blue GRN = Green
BRO = Brown HAZ = Hazel
BLK = Black WHI = White
BRO = Brown BAL = Bald
GRY = Gray BLN = Blonde
RED = Red

Florida Department of Agriculture and Consumer Services Division of Licensing

APPLICATION FOR SECURITY OFFICER LICENSE

Chapter 493, Florida Statutes
Rule 5N-1.100, Florida Administrative Code
Post Office Box 5767sTallahassee, FL 32314-5767s(850) 245-5691
www.mylicensesite.com

BEFORE YOU BEGIN, read the Application Instructions. TYPE or PRINT using black ink. To help avoid unnecessary delay in the processing of your application, be sure to answer all questions and submit any necessary documentation.

SECTION I APPLICANT INFORMATION

SECTION II          MILITARY HISTORY

If you are not a U.S. Citizen, you must submit proof of current employment authorization issued by the Department of Homeland Security, U.S. Citizenship and Immigration Services (USCIS). A COPY of the front and back of one of the following USCIS forms is sufficient: I-551, I-766.

SECTION III          CRIMINAL HISTORY

SECTION IV           ALIAS INFORMATION

SECTION V        PERSONAL HISTORY

SECTION VI         TRAINING/EXPERIENCE

SECTION VII           CERTIFICATION OF QUALIFIED EXEMPTION FROM PUBLIC RECORD DISCLOSURE

SECTION VIII              CITIZENSHIP

SECTION IX                  PERSONAL INQUIRY WAIVER AND NOTARIZATION STATEMENT

THIS APPLICATION IS EXECUTED UNDER OATH. FALSIFICATION OR MISREPRESENTATION OF ANY PART OR ANY DOCUMENT SUBJECTS THE APPLICANT TO CRIMINAL PROSECUTION UNDER SECTION 837.06, FLORIDA STATUTES

Do not sign the application until you are in the presence of the Notary Public who will notarize your application.

I certify that I understand that the Division of Licensing will conduct any investigation deemed necessary to ensure that I have met all statutory requirements for licensure. I understand that inquiry shall be made regarding my criminal history and that subsequent investigation may include my school records, employment history, financial records, any history of controlled substance or alcohol abuse, and my mental capacity.

I hereby waive any provision of law forbidding any school official, court, police agency, employer, firm or person from disclosing to the Division any knowledge or information concerning me, and I do certify that I give permission for such entity to disclose any information and to provide any record requested concerning me to the Division.

I also affirm that the information contained in this application and all attachments I have submitted to be true and correct to the best of my knowledge. I understand that falsification of any information or documentation submitted with this application may be grounds for denial or revocation of the license.

The foregoing application was sworn to (or affirmed) and subscribed before me this

SECTION X                   EMPLOYER STATEMENT  (to be completed by applicant’s employer)