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    Division of State Police 1111 Country Club Road Middletown, CT 06457-9294

    Uploaded by

    Scott Ennis
    This document is an application for a private detective or security service license in the state of Connecticut. It requests personal information from the applicant such as name, address, citizenship status, education history, employment history, and criminal/motor vehicle records. It also requests information about the proposed business such as trade name, addresses, and names of corporate officials. The applicant must submit documentation like photos, proof of training/experience, background checks, and letters of reference along with payment for fingerprinting fees.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Division of State Police 1111 Country Club Road Middletown, CT 06457-9294

    Uploaded by

    Scott Ennis
    103 views4 pages
    This document is an application for a private detective or security service license in the state of Connecticut. It requests personal information from the applicant such as name, address, citizenship status, education history, employment history, and criminal/motor vehicle records. It also requests information about the proposed business such as trade name, addresses, and names of corporate officials. The applicant must submit documentation like photos, proof of training/experience, background checks, and letters of reference along with payment for fingerprinting fees.

    Original Description:

    CT PI license info sheet.

    Original Title

    DPS366CApplicationforPrivateDetectiveorSecurityServiceLicenseRev120117pdf

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    © © All Rights Reserved

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    This document is an application for a private detective or security service license in the state of Connecticut. It requests personal information from the applicant such as name, address, citizenship status, education history, employment history, and criminal/motor vehicle records. It also requests information about the proposed business such as trade name, addresses, and names of corporate officials. The applicant must submit documentation like photos, proof of training/experience, background checks, and letters of reference along with payment for fingerprinting fees.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    103 views4 pages

    Division of State Police 1111 Country Club Road Middletown, CT 06457-9294

    Uploaded by

    Scott Ennis
    This document is an application for a private detective or security service license in the state of Connecticut. It requests personal information from the applicant such as name, address, citizenship status, education history, employment history, and criminal/motor vehicle records. It also requests information about the proposed business such as trade name, addresses, and names of corporate officials. The applicant must submit documentation like photos, proof of training/experience, background checks, and letters of reference along with payment for fingerprinting fees.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    STATE OF CONNECTICUT

    DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION


    DIVISION OF STATE POLICE
    1111 Country Club Road Middletown, CT 06457-9294

    Application for Private Detective or Security Service License

    Check Type of License Desired:


    Individual (including DBA) Corporate (including LLC & Inc.)
    Private Detective Private Detective, Inc.
    Private Detective Fire Investigator Private Detective Fire Investigator, Inc.
    Security Service Security Service, Inc.

    Applicant is: Licensee Corporate Official Proprietary Licensee


    Personal information:
    Name of Applicant Social Security #:

    Date of Birth Place of Birth Height Weight Sex

    Hair Color Eye Color Scars/Marks/Tattoos Race

    Firearms Permit No./State Driver's License No./State

    Home phone Business phone

    Address

    Prior home addresses for past five years: (use additional paper if needed)
    From To Street/City/Town/State/Zip

    Employment history – Begin with present or most current and work backwards, Include dates of employment, duties/responsibilities, reason
    for leaving employment. (Use additional paper if needed or attach resume)

    Statement of Citizenship: (attach proof of citizenship)


    Are you a citizen of the United States? If naturalized, detail when and where:
    Yes No
    Have you ever used any other name(s)? If so, list name(s) used: (Use additional paper if needed)

    DPS-366-C (Revised 5/06/19) Page 1


    An Affirmative Action / Equal Opportunity Employer
    Are you currently vested with police powers? Yes No
    Education: (Indicate highest degree received (Attach copy of high school diploma/GED certificate or college transcript)
    Degree/Diploma Year Degree Awarded: Name of College/University
    High School
    Associate Degree
    Baccalaureate Degree
    Masters/Doctorate Degree
    Other _______________
    List any schools or courses, which you believe qualifies you for the type of license applied for:
    (The Commissioner of Emergency Services and Public Protection may, at his/her discretion, substitute up to one year of experience upon proof of
    satisfactory participation in a course of instruction pertinent to the license applied for. Include copies of training certificates. (Attach additional
    sheets of paper as required).

    Private Investigator Applicants: Does the applicant meet the minimum five years of full time
    investigative experience or ten years of experience as a police officer with a state or organized
    municipal police department? Yes No If "No " Explain: (Submit qualifying documentation)
    (Please reference CGS 29-154a)
    Security Applicants: Does the applicant meet the minimum five years supervisory experience under a
    licensed security agency or ten years as a police officer with a state or organized municipal police
    department? Yes No If "No " Explain: (Submit qualifying documentation)
    (Please reference CGS 29-161h)
    Criminal and Motor Vehicle Record:
    Have you ever been arrested for a criminal offense? Yes No If Yes, explain:
    Date/Place Jurisdiction/Court Charge

    Have you ever been arrested on a motor vehicle charge? Yes No If Yes, explain:

    Date/Place Jurisdiction/Court Charge

    DPS-366-C (Revised 5/06/19) Page 2


    An Affirmative Action / Equal Opportunity Employer
    Military Service: Yes No ( If "Yes" DD-214 or NGB-22 must be attached)

    Military branch or component Highest Rank Attained Type of Discharge

    Business Information:
    Proposed Trade Name* Address of Home Office

    Type Organization Date & Place of Incorporation (attach Certificate of Incorporation or


    Trade Certificate)
    Individual Corporate

    Connecticut Addresses Telephone Numbers


    _______________________

    _______________________

    _______________________

    ________________________
    Branch Manager’s Name:& D.O.B.

    * Subject to approval by the Commissioner of Emergency Services and Public Protection.


    Names, addresses, dates of birth, and proposed titles of all corporate officials:
    (use additional paper if necessary)

    Are you currently licensed as a private investigator/security service in any other state?
    Yes No If "Yes," Explain:

    State Lic. Number Type of License Date License Expires

    DPS-366-C (Revised 5/06/19) Page 3


    An Affirmative Action / Equal Opportunity Employer
    You must submit the following items with this application. (Use check boxes to indicate items are attached.
    Incomplete packages will be returned)

    Two photographs (2" x 2" passport style) DD-214 or NGB-22, military discharge documentation
    which includes type of discharge and reenlistment codes

    Verification from State Agency High school diploma/ GED cert., college transcript
    or other proof of training

    Documentation of employment Full credit bureau report; summary not accepted

    Copy of Motor Vehicle Driver’s License Trade name, LLC or Incorporation papers.

    One fingerprint card - green (state card) with $75.00 payable to Treasurer, State of Connecticut, and $13.25 payable
    to Treasurer, State of Connecticut. Submit fingerprint card with cashier’s check or money order.

    Motor vehicle abstract for LICENSEE only, for the past three years. Obtain the abstract from the motor vehicle licensing agency in
    the state of the licensee's residence for the past three years.

    Also required are four letters of personal reference, LICENSEE ONLY. These letters of reference must be original letters and must
    be sent directly from the author to the Special Licensing & Firearms Unit. FORM LETTERS ARE NOT ACCEPTABLE AND WILL BE
    RETURNED.

    Corporate Applicants: Submit this application (DPS-366-C) along with:

    One fingerprint card - green (State of Connecticut Applicant) with $75.00 payable to Treasurer, State of Connecticut and $13.25
    payable to the Treasurer, State of Connecticut. Submit fingerprint card with cashier’s check or money order.

    Two photographs (approximately 2" x 2" passport style)

    Proprietary Applicants:

    Submit only the DPS-366-C – NO FEES OR ADDITIONAL DOCUMENTATION REQUIRED.

    Applications must be complete.


    Authorization for Release of Personal Information
    All of the information on this application must be verifiable or it will not be considered for licensing. False, misleading or
    omitted information may be the basis for denial of a license. "Any person who violates any provision shall be fined not
    more than $5,000.00 or imprisoned for not more than one year or both."

    ___________________________________
    (Signature of Applicant)
    STATE OF

    SS ___________________________________
    Date of Oath

    COUNTY OF: PERSONALLY APPEARED: _________________

    ADDRESS:

    Signer of the foregoing application and made oath of truth of matters contained before me.

    Notary Public, Justice of Peace or Commissioner of Superior Court


    My Commission Expires:

    DPS-366-C (Revised 5/06/19) Page 4


    An Affirmative Action / Equal Opportunity Employer

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