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INFORMATION ABOUT LICENSING

PRIVATE PATROL OPERATOR AND PRIVATE PATROL OPERATOR QUALIFIED MANAGER

This packet contains information about obtaining a Private Patrol Operator license and a Private

Patrol Operator Qualified Manager certificate, descriptions of required qualifications, and license

application forms. It is the policy of the Bureau of Security and Investigative Services (Bureau) to

provide equal licensing opportunities for all persons without regard to race, color, religion, sex,

national origin, disability, age, creed, marital status or sexual orientation.

The Bureau licenses and regulates Private Patrol Operators in California under the provisions of the:

• California Business and Professions Code 7580-7588.5

• California Code of Regulations (formerly California Administrative Code)

Title 16, Division 7, sections 600.1 – 645

No person may engage in the business of a Private Patrol Operator in California without obtaining the

proper license from this Bureau. Any person who operates without a license, unless exempted, or

who represents himself or herself to be licensed and is not licensed, is guilty of a misdemeanor,

which is punishable by a fine and/or imprisonment. Licensing laws and regulations are subject to

change. Applicants are responsible for staying informed of legislative or regulatory changes which

may affect the status of their application. If any such changes affect the status of an application after

it has been filed with the Bureau, the applicant will be notified.

FEE AMOUNT AND PAYMENT

Two separate fees are required to process a Private Patrol Operator application for an initial license:

the $550 initial application and exam fee and the $770 initial license fee ($1,320 total). Be advised

that an application received without payment of the full application/examination fee amount

owed will not be processed and will be returned to the applicant. Make check payable to Bureau

of Security and Investigative Services or BSIS. Do not submit cash by mail. Application fees are

non-refundable.

GENERAL QUALIFICATIONS FOR LICENSURE

Each person listed on the application (owner, partner, corporate officer, qualified manager) is required

to meet certain general qualifications regarding fitness for licensure.

The person who will be in active charge of the business for a Private Patrol Operator is referred to as

the qualified manager. Each company license must have one person designated as the qualified

manager and that person must meet the general license qualifications, as well as more specific

qualifications regarding age, experience and examination. The qualified manager may be an owner,

partner, corporate officer or any other person meeting the requirements for a qualified manager.

DENIAL OF LICENSURE

A criminal history check is made on all applicants through the completion of a Department of Justice

(DOJ) and Federal Bureau of Investigation (FBI) Live Scan. The director may deny a license if any

person listed on the application as an owner, partner, corporate officer or qualified manager have

done any of the following:

• Been convicted of a crime substantially related to the qualifications, functions or duties of the

business or profession for which the application is made.

• Committed any act involving dishonesty, fraud or deceit with the intent to substantially benefit

himself or herself or injure another.

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• Committed any act which, if done by a licensee of the business or profession in question,

would be grounds for suspension or revocation of the license.

• Knowingly made a false statement of fact required to be revealed on the license application.

• Had a license which is under suspension.

• Been refused a license or had a license revoked, or been an owner, partner, corporate officer

or qualified manager of any business that has been refused a license or had a license revoked

by the Bureau.

• While unlicensed, committed, or aided and abetted the commission of, any act for which said

license is required.

APPLICATION PROCESSING TIMEFRAME

The following items may affect the time required to process your application: incomplete

application forms; incorrect or nonpayment of fees; passing the examination; the DOJ and FBI’s

response time on criminal history checks; and the time required to verify application information.

Please allow a minimum of four weeks before contacting the Bureau regarding the status of an

application.

FORMS REQUIRED FOR LICENSE APPLICATION

The following is a description of each type of form that must be included with your application. All

required forms must be completed and submitted to the Bureau with the appropriate fees before the

application will be processed. The attached Private Patrol Operator Application Forms Checklist on

page 7 lists the forms required for a Private Patrol Operator license. Please check the completed

application package against this list before submitting it to the Bureau.

APPLICATION FOR LICENSE (Form 31A-4) (fee required)

A separate Private Patrol Operator application must be filed for each entity applying for a license. For

example, if a Private Patrol Operator sole owner wants to have a partnership with someone else, the

sole owner must file two separate Private Patrol Operator applications.

Licenses are not transferable or assignable to new entities, and a change in ownership constitutes a

new entity, with a newly assigned Private Patrol Operator license number.

If the type of ownership/entity is changed after filing an application or after becoming licensed, a new

application must be submitted with the appropriate fees. For example, if a licensed sole owner later

decides to form a partnership or corporation, the sole owner must apply for a new license to do

business as a partnership or corporation.

Note: If applying for a Private Patrol Operator Qualified Manager license only, there is no need to

complete the Application for License (Form 31A-4).

Business address: A post office box or mailbox service may not be used as the address of record

unless mail delivery to the physical location of the business is not possible or the principal place of

business is located in the applicant/licensee’s personal residence. If a post office box or mailbox

service is listed as the business address, the licensee should provide an explanation for doing so with

the application and provide the actual physical location/address of the business in the accompanying

explanation.

2

Insurance Requirement: ALL licensed Private Patrol Operators must maintain general liability

insurance as a condition of licensure. Specifically, Private Patrol Operators are required to have

commercial general liability insurance policies which provide minimum limits of one million dollars

($1,000,000) for any one loss or occurrence due to bodily injury, including death, or property damage,

or both.

Since the Certificate of Liability must include your company’s name, the Bureau recommends that

applicants wait until receiving written authorization from the Bureau of your business name before

submitting the Certificate of Liability Insurance document.

Private Patrol Operator applicants and licensees must submit a Certificate of Liability Insurance to the

Bureau as proof that the insurance requirement is being met. The Certificate of Liability Insurance

must include:

• Your company name;

• The insurance policy number; and

• The dates the coverage of insurance commenced and expires.

Current licensees submitting updated Certificates of Liability Insurance need to include their Private

Patrol Operator license number on the Certificate of Liability Insurance. Failure to provide or maintain

proof of liability insurance with the Bureau shall result in an automatic suspension of the Private

Patrol Operator license. All Private Patrol Operators are responsible for ensuring the Bureau has

current insurance information on file at all times, which means all Private Patrol Operators must

submit a new Certificate of Liability Insurance when a current policy expires.

Corporation Applicants: If applying for licensure as a corporation, include an endorsed copy of the

Articles of Incorporation (Domestic Corporation) or an endorsed copy of the Statement and

Designation by Foreign Professional Corporation Form (Foreign Corporation) filed with the California

Secretary of State. A copy of the Statement of Information, filed with the Secretary of State, must

also accompany the application.

PERSONAL IDENTIFICATION FORM (Form 31A-9) (no fee required)

Each person listed on the Private Patrol Operator Application for License as an owner, partner,

corporate officer and/or qualified manager of the business must complete one of these forms and

submit one passport quality photograph, taken within the past year. Any person who knowingly

falsifies photographs required for licensure is guilty of a felony.

QUALIFIED MANAGER - GENERAL REQUIREMENTS

QUALIFYING EXPERIENCE FORM (Form 31A-8) (no fee required)

This form must be completed for persons applying for examination as a qualified manager for a

Private Patrol Operator license. All qualifying experience for the qualified manager must be

certified on this form by someone other than the applicant. A separate form is to be used by

each person who is certifying experience and for each employer. All military qualifying experience

must be supported by a copy of the applicant’s DD-214 or Performance Evaluation Report. Additional

support of experience may be required as requested by the Bureau. One year of experience is

equivalent to a minimum of 2,000 hours of compensated time in the required field.

3

The person who is designated as the qualified manager must meet these general requirements in

addition to the experience requirement listed below:

• Be at least 18 years of age.

• Attain a passing score on the written examination.

• Have at least one year of compensated experience totaling not less than 2,000 hours as a

patrolman, guard or watchman, or the equivalent thereof.

Note: If an applicant has previously passed the examination for a Private Patrol Operator Qualified

Manager and/or currently holds a valid license, the applicant does not have to retake the exam.

Examination: Examinations are designed to determine proficiency of the applicant to engage in the

business of a Private Patrol Operator, as a qualified manager. In order to be considered for

examination, the Bureau must receive the completed application and appropriate fee(s).

After the application is approved, the applicant’s name and address will be sent to Psychological

Services Industry (PSI). PSI will mail the applicant a candidate handbook and study materials. Upon

receipt of this information the applicant may contact PSI at the phone number provided in the

handbook and schedule the date, time and location for examination.

Disclaimer: Successfully passing the Private Patrol Operator examination does not guarantee that

an applicant will be issued a Private Patrol Operator license from the Bureau.

Examinees requiring special testing arrangements due to a physical or mental impairment must

submit a request to the Bureau for such arrangements. This request must be in writing and include

supporting documentation from a physician or other qualified professional.

Re-Examination: If the applicant does not pass the Private Patrol Operator exam, or is unable to

attend the scheduled exam date, the applicant may apply to sit for the exam at a later date by

submitting a written request or an application for re-examination (form is attached to the results

notice) and the appropriate fee. The applicant will receive the candidate handbook and study

materials from PSI. Once this information is received, the applicant may schedule an appointment

with PSI to take the exam.

REQUEST FOR AUTHORIZATION OF BUSINESS NAME (Form 31A-12) (no fee required)

Business may not be conducted under a fictitious or other business name unless written authorization

is received from the Bureau.

The Bureau recommends that applicants wait until the issuance of a Private Patrol Operator license

before incurring expenses related to the use of the name, e.g., stationery, business cards,

advertising, telephone listings, etc. for the Private Patrol Operator Company. Approval of a

corporate name by the Secretary of State does not mean the name will be automatically

approved as a business name by the Bureau.

The Request for Authorization of Business Name form will not be processed before receipt of an

application and fees. List business names to be considered in order of preference. Name approval

or disapproval is not available by telephone. Applicants who have already passed the required

examination will be notified of name approval or disapproval after review and acceptance of the

application. New applicants will be advised of name approval or disapproval with notification of

passing the written examination.

Note: If applying for a Private Patrol Operator Qualified Manager license only, there is no need to

complete the Request for Authorization of Business Name (Form 31A-12).

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LIVE SCAN SITES AND FORMS

Live Scan is a system for the electronic submission of fingerprints and the subsequent automated

background checks and responses. Simply go to the nearest Live Scan station to submit fingerprints

to the DOJ and FBI. Visit the Bureau’s website to view a list of Live Scan sites and/or Live Scan

forms: https://www.bsis.ca.gov/forms_pubs/livescan/criminalhistory_bgcheck.pdf.

Disclaimer: Please request the Live Scan operator to include your social security number (SSN) or

individual taxpayer identification number (ITIN) when keying your information in order to aid the

Bureau in processing your application.

FINGERPRINT CARDS

CALIFORNIA RESIDENTS: The Department of Justice, with rare exceptions, will only accept

electronically submitted (Live Scan) fingerprints for criminal background checks related to

employment, licensing, certification, etc. California residents who do not have reasonable access to

Live Scan or have a justifiable reason to submit a fingerprint card may request fingerprint cards from

the Bureau for submission.

NON-RESIDENTS: Out-of-state applicants will be deemed to lack reasonable access to Live Scan.

Accordingly, hard fingerprint cards for such individuals will not be subject to the limitations described

above.

The items listed below are required for fingerprint card submissions for each person applying for

approval as a Private Patrol Operator Qualified Manager and each person listed on the application for

licensure as an owner, partner, or corporate officer.

• Two completed fingerprint cards

• Include payment of $49.00

ABANDONMENT OF APPLICATIONS

If the applicant does not complete the license application process within one year after filing the

application with the Bureau, or if does not pass the examination within a one-year period after

becoming eligible, the application will be considered abandoned. The date the application will be

considered abandoned is included in the applicant’s examination scheduling letter. Once the

application is considered abandoned, the applicant will be required to submit a new Live Scan form, a

new application and appropriate fees.

FINAL STEPS IN THE LICENSING PROCESS

When all requirements are met for licensing, including the requirements for the qualified manager, the

applicant will be notified to send the following items:

• License fee, if not already paid (see Private Patrol Operator Company Schedule of Fees).

• Any additional information needed to complete the application.

• Certificate of Liability Insurance

• For Applicants Who Applied As A Corporation: An endorsed copy of the Articles of

Incorporation (Domestic Corporation) or an endorsed copy of the Statement and Designation

by Foreign Professional Corporation Form (Foreign Corporation) filed with the California

Secretary of State, if not already submitted.

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PRIVATE PATROL OPERATOR COMPANY SCHEDULE OF FEES

Fee Type Fee Amount

Initial Application and Exam

$550

Initial License

$770

Total Initial Fee

$1,320

Qualified Manager Exam

$550

Qualified Manager Re-Exam

$60

Biennial Company Renewal

$900

Delinquent Company Renewal

($900 renewal fee + $450 delinquency fee)

$1,350

Replacement Company License

(Large or Small Wall)

$25

Replacement Company Pocket Card

(for Company Principals or Qualified Managers)

$25

ANY QUESTIONS?

If you have questions regarding the Private Patrol Operator licensing process or about completion of

your application, you may contact the Bureau at:

Bureau of Security and Investigative Services

P.O. Box 989002

West Sacramento, CA 95798-9002

(800) 952-5210

(916) 322-4000

PrivateSecurityServices@dca.ca.gov

Although every effort has been made to assure the accuracy of this information packet, it

does not have the force and effect of law, rule or regulation. Should any difference or error

occur, the law will take precedence.

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PRIVATE PATROL OPERATOR AND PRIVATE PATROL OPERATOR

QUALIFIED MANAGER APPLICATION FORMS CHECKLIST

APPLICATION AND FINGERPRINT PROCESSING FEES ARE NON-REFUNDABLE.

This form is for your use only. Please do not submit it to the Bureau with your application. Check off each

form that you have completed. When all pertinent forms are checked off, submit your application package and

appropriate fees to the Bureau. Make checks payable to the Bureau of Security and Investigative Services.

PRIVATE PATROL OPERATOR

If you do not have a qualified manager who already has a current qualification certificate, you must also

send the forms listed for the qualified manager. If you are applying only to become certified as a

private patrol operator qualified manager, do not complete these forms – see forms list for qualified

manager.

 Application for License (Form 31A-4)

Application Processing Fee/

Examination Fee: $550

 Personal Identification Form (Form 31A-9)

One form and one passport quality photograph, taken within

the past year, for each owner, partner, corporate officer and

License Fee (Fee payable once

manager.

a certified qualified manager is in

place): $770

 Request for Authorization of Business Name (Form 31A-12)

 Certificate of Liability Insurance

 Corporation Applicants Only: (1) Copy of endorsed Articles

of Incorporation (Domestic Corporation) or a copy of endorsed

Statement and Designation by Foreign Professional

Corporation Form (Foreign Corporation) filed with the

California Secretary of State. (2) Copy of Statement of

Information filed with the Secretary of State.

 Corporation or Partnership Applicants Only: In order to

access BreEZe, the Bureau’s online licensing and enforcement

system, you must include your Federal Employer Identification

Number (FEIN) on page 8 of your application packet.

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QUALIFIED MANAGER ONLY

 Personal Identification Form (Form 31A-9)

One form and one passport quality photograph, taken within

the past year.

Examination Fee (Payable if only

taking the Qualified Manager

exam): $550

NOTE: The application/examination fee paid with the Private

Patrol Operator (PPO) application provides for the Qualified

Manager (QM) associated with the application to sit for the

examination.

 Qualifying Experience (Form 31A-8)

One form from each person who is certifying the required work

experience.

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__________________________________

_____________________________

BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY • GAVIN NEWSOM, GOVERNOR

DEPARTMENT OF CONSUMER AFFAIRS

BUREAU OF SECURITY AND INVESTIGATIVE SERVICES

P.O. Box 989002, West Sacramento, CA 95798-9002

P (916) 322-4000 | P (800) 952-5210 | F (916) 575-7290 | www.bsis.ca.gov

PRIVATE PATROL OPERATOR

APPLICATION FOR LICENSE

DO NOT LIVE SCAN UNTIL YOU HAVE SUBMITTED YOUR APPLICATION

This information is requested pursuant to California Business and Professions Code section 7582 and 7582.7 and will be used to determine eligibility

for licensure. All information is necessary and if not provided, the application may be rejected. You must submit the application/licensing fee(s) with

your application package. Failure to do so may delay the processing of your application. Please note that the application processing

fee/examination fee and/or license fees are non-refundable.

If the qualified manager has already passed the Bureau examination and is still eligible to be a qualified manager, you may submit the application

processing fee and the exam fee with this application.

PLEASE TYPE OR PRINT CLEARLY.

1. Proposed Business Name

2. Business Address (Physical Location) Number and Street City

State Zip Code

3. Mailing Address (If Applicable) Number and Street City State Zip Code

4. Qualified Manager’s Full Name

5. Qualified Manager License Number (if licensed)

6. Telephone – Business Residence

( ) ( )

7. Type of Business Organization

 Individual

 Partnership

 Corporation

SSN or ITIN (Individual Ownership Only)

FEIN (Corporation or Partnership Only)

Secretary of State Identification Number

(Corporation Only)

List the name of each owner, partner, or corporate officer of the business and identify their position. For corporations list chief executive officer,

secretary, chief financial officer, and any other corporate officer who will be active in the business. If additional space is needed, attach a separate

sheet.

Name – Last

First

Middle

Position

Telephone

( )

Each person listed in items 3 and 7 must complete and submit a Private Patrol Operator Personal Identification Form (Form 31A-9), even though the

person may have previously submitted this information in connection with another license.

I/We declare under penalty of perjury, under the laws of the State of California, that all information contained on this Application for License and

any accompanying documents is true and correct, with full knowledge that all statements made in this form are subject to investigation and that ANY

FALSE OR DISHONEST ANSWER TO ANY QUESTION MAY BE GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF

LICENSE.

Signature Date

SIGNATURES REQUIRED: Individuals whose names appear in item 4 and 7.

Submission of the requested information is mandatory. The Bureau of Security and Investigative Services cannot consider your application for

licensure or renewal unless you provide all of the requested information.

Pursuant to the California Public Records Act (Gov. Code § 6250 et seq.) and the Information Practices Act (Civ. Code § 1798.61), the names and

addresses of persons possessing a license or registration may be disclosed by the Department unless otherwise specifically exempt from disclosure

under the law. We make every effort to protect the personal information you provide us. The information you provide, however, may be disclosed in

response to a court or administrative order, a subpoena, or a search warrant.

(See Next Page for Additional Information)

9 31A-4 (Rev. 07/2020)

Per the Information Practices Act, the Chief of the Bureau of Security and Investigative Services, Department of Consumer Affairs, is responsible for

maintaining the information in this application. You have the right to review the records maintained on you by the Bureau or Department unless the

records are exempt from disclosure by section 1798.40 of the Civil Code.

Your completed application becomes the property of the Bureau and will be used by authorized personnel to determine your eligibility for a license,

registration or permit. Information on your application may be transferred to other governmental or law enforcement agencies, as permitted by law.

For questions about this notice or access to your record, you may contact the Bureau by mail at Bureau of Security and Investigative Services, Attn:

Public Records Liaison, P.O. Box 980550, Sacramento, CA 95798-0550, by phone at (916) 322-4000 or (800) 952-5210, or by e-mail at

bsis.prarequests@dca.ca.gov. For questions about the Department’s Privacy Policy, you may contact the Department of Consumer Affairs at 1625

North Market Boulevard, Sacramento, CA 95834, by phone at (800) 952-5210 or by e-mail at dca@dca.ca.gov.

10 31A-4 (Rev. 07/2020)

BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY • GAVIN NEWSOM, GOVERNOR

DEPARTMENT OF CONSUMER AFFAIRS

BUREAU OF SECURITY AND INVESTIGATIVE SERVICES

P.O. Box 989002, West Sacramento, CA 95798-9002

P (916) 322-4000 | P (800) 952-5210 | F (916) 575-7290 | www.bsis.ca.gov

PERSONAL IDENTIFICATION FORM

PRIVATE PATROL OPERATOR, PRINCIPALS, CORPORATE OFFICERS,

AND PRIVATE PATROL OPERATOR QUALIFIED MANAGER

DO NOT LIVE SCAN UNTIL YOU HAVE SUBMITTED YOUR APPLICATION

Each person listed on the Private Patrol Operator Application for License (Form 31A-4) as an owner, partner, corporate officer,

and qualified manager of the business must complete and submit this form. This form is also to be completed for any change

in corporate officer or qualified manager after the license is issued. A corporate officer includes the chief executive officer,

secretary, chief financial officer and any other officer who will be active in the business. This form must be accompanied by

one passport quality photograph, taken within the past year.

This information is requested pursuant to California Business and Professions Code sections 480, 7582.6, 7582.19 and Labor

Code section 432.7 and will be used to determine eligibility for licensure. All information is necessary, and if not provided, the

application may be rejected.

Have you served or are currently serving in the United States military?

Yes* No

In order to assist veterans in their transition from military service to civilian employment, BSIS has implemented the Veterans

Come First Program which offers priority services to veteran applicants. Disclosure of military service is voluntary and

participation in the program is optional. If you choose to use the Veteran’s Come First Program, check the military status box

and submit proof of military service (e.g. DD-214, DD-256, V-MET record, military orders, military I.D., etc.) along with your

application.

REFUGEE, ASYLEE, OR SPECIAL IMMIGRANT VISA HOLDER APPLICANTS

Business and Professions Code section 135.4 provides that the Bureau must expedite, and may assist, the initial licensure

process for certain applicants described below. This does not apply to applicants whose business is structured as a

partnership or corporation.

☐

Check this box if any of the following statements apply to you:

• You were admitted to the United States as a refugee pursuant to section 1157 of title 8 of the United States Code;

• You were granted asylum by the Secretary of Homeland Security or the United States Attorney General pursuant to

section 1158 of title 8 of the United States Code; or,

•

You have a special immigrant visa and were granted a status pursuant to section 1244 of Public Law 110-181, Public

Law 109-163, or section 602(b) of title VI of division F of Public Law 111-

8, relating to Iraqi and Afghan

translators/interpreters or those who worked for or on behalf of the United States government.

Disclosure is voluntary. If you checked the box above you must attach evidence/documentation of your status as a

refugee, asylee, or special immigrant visa holder. Failure to do so may result in application review delays.

ACCEPTABLE EVIDENCE/DOCUMENTATION

• Form I-94, Arrival/Departure Record, with an admission class code such as “RE” (Refugee) or “AY” (Asylee) or other

information designating the person a refugee or asylee.

• Special immigrant visa that includes the visa category of “SI” or “SQ.”

• Permanent Resident Card (Form I-551), commonly known as a “Green Card,” with a category designation indicating

that the person was admitted as a refugee or asylee.

• An order from a court of competent jurisdiction or other documentary evidence that provides reasonable assurance that

the applicant qualifies for expedited licensure.

11 31A-9 (Rev. 11/2020)

PLEASE TYPE OR PRINT CLEARLY.

1. This application is for a:

Private Patrol Operator License

Private Patrol Operator Qualified Manager

2. A change in an existing license:

Corporate Officer

Other

Qualified Manager

3. Name of Qualified Manager (Please Print)

4. Business Name

5. License Number (if licensed)

6. Full Name Last First Middle

7. SSN or ITIN (Mandatory)

8. Date of Birth (Mo/Day/Yr)

9. Residence Address – Number and Street City State Zip Code

10. Telephone Number

Residence ( ) Business ( )

11. Email Address

12. YOUR POSITION WITH BUSINESS: (Check all that apply)

OWNER

QUALIFIED MANAGER

__________________________

PARTNER OFFICER

OFFICE HELD

13. Have you ever applied for or received a license or registration from the

Department of Consumer Affairs, the Department of Professional and Vocational

Standards, Bureau of Private Investigators and Adjusters, the Collection Agency

Licensing Bureau, the Bureau of Collection and Investigative Services, or the Bureau

of Security and Investigative Services?

YES

NO

14. Have you or any partnership or corporation of which you were a member or

officer had any license denied, suspended or revoked by any state, territory, or

governmental agency?

YES

NO

15. Have you ever used a name other than your present legal name?

YES

NO

IMPORTANT

: If you answered “YES” to any of the preceding questions, attach a supplementary

statement giving a complete and detailed explanation, including dates, names used, license numbers,

reasons, etc.

12 31A-9 (Rev. 11/2020)

__________________________________________________ ______________________________

16. EMPLOYMENT HISTORY: Your past five-year employment history must be shown. List most recent experience first. Qualified managers

must list one year of qualifying experience and attach their completed Qualifying Experience forms for any

experience used to qualify for the license examination. If additional space is needed, attach a separate sheet.

NAME OF EMPLOYER TELEPHONE NUMBER

( )

DUTIES PERFORMED

:

ADDRESS: NUMBER STREET CITY STATE ZIP CODE

YOUR POSITION TITLE SUPERVISOR

’

S NAME

DATES EMPLOYED (Month/Day/Year)

From: To:

TOTAL NUMBER OF HOURS WORKED

NAME OF EMPLOYER TELEPHONE NUMBER

( )

DUTIES PERFORMED

:

ADDRESS: NUMBER STREET CITY STATE ZIP CODE

YOUR POSITION TITLE SUPERVISOR

’

S NAME

DATES EMPLOYED (Month/Day/Year)

From: To:

TOTAL NUMBER OF HOURS WORKED

NAME OF EMPLOYER TELEPHONE NUMBER

( )

DUTIES PERFORMED

:

ADDRESS: NUMBER STREET CITY STATE ZIP CODE

YOUR POSITION TITLE SUPERVISOR

’

S NAME

DATES EMPLOYED (Month/Day/Year)

From: To:

TOTAL NUMBER OF HOURS WORKED

17. List your residence addresses for the past five years. Give the most recent first, using additional sheets if necessary.

NUMBER AND STREET CITY STATE ZIP CODE

FROM TO

ATTENTION – READ THE FOLLOWING PARAGRAPH CAREFULLY BEFORE SIGNING THIS FORM

I declare under penalty of perjury, under the laws of the State of California, that all information contained on this Personal Identification Form and

any accompanying documents is true and correct, with full knowledge that all statements made in this application are subject to investigation and that

any false or dishonest answer to any question may be grounds for denial or subsequent revocation of a license.

SIGNATURE

Attach one passport

quality photograph, taken

within the past year

DATE

Pursuant to Business and Professions Code section 30, providing your social security number or individual taxpayer identification

number is mandatory and will be used exclusively for tax enforcement purposes and for compliance with any judgment or order for

family support in accordance with section 17520 of the Family Code. Your social security number or individual taxpayer

identification number may also be used for verification of licensure or examination status for national examination where licensure

is reciprocal with a requesting state. If you fail to provide your social security number or individual taxpayer identification number,

you will be reported to the Franchise Tax Board, which may assess a $100 penalty against you.

Submission of the requested information is mandatory. The Bureau of Security and Investigative Services cannot consider your

application for licensure or renewal unless you provide all of the requested information.

Pursuant to the California Public Records Act (Gov. Code § 6250 et seq.) and the Information Practices Act (Civ. Code § 1798.61),

the names and addresses of persons possessing a license or registration may be disclosed by the Department unless otherwise

specifically exempt from disclosure under the law. We make every effort to protect the personal information you provide us. The

information you provide, however, may be disclosed in response to a court or administrative order, a subpoena, or a search warrant.

Per the Information Practices Act, the Chief of the Bureau of Security and Investigative Services, Department of Consumer

Affairs, is responsible for maintaining the information in this application. You have the right to review the records maintained on

you by the Bureau or Department unless the records are exempt from disclosure by section 1798.40 of the Civil Code. Your

completed application becomes the property of the Bureau and will be used by authorized personnel to determine your eligibility

for a license, registration or permit. Information on your application may be transferred to other governmental or law enforcement

agencies, as permitted by law.

For questions about this notice or access to your record, you may contact the Bureau by mail at Bureau of Security and

Investigative Services, Attn: Public Records Liaison, P.O. Box 980550, Sacramento, CA 95798-0550, by phone at (916) 322-4000

or (800) 952-5210, or by e-mail at bsis.prarequests@dca.ca.gov

. For questions about the Department’s Privacy Policy, you may

contact the Department of Consumer Affairs at 1625 North Market Boulevard, Sacramento, CA 95834, by phone at (800) 952-

5210 or by e-mail at dca@dca.ca.gov.

13 31A-9 (Rev. 11/2020)

BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY • GAVIN NEWSOM, GOVERNOR

DEPARTMENT OF CONSUMER AFFAIRS

BUREAU OF SECURITY AND INVESTIGATIVE SERVICES

P.O. Box 989002, West Sacramento, CA 95798-9002

P (916) 322-4000 | P (800) 952-5210 | F (916) 575-7290 | www.bsis.ca.gov

PRIVATE PATROL OPERATOR

REQUEST FOR AUTHORIZATION OF BUSINESS NAME

Any name under which you intend to do business, including your own name, must be submitted to the Bureau for approval pursuant to California

Business and Professions Code section 7582.17. A Request for Authorization of Business Name form will not be accepted prior to an application for

a license. Business may not be conducted under a fictitious or other business name unless written authorization is received from the Bureau. Any

advertisement must contain the exact business name as approved by the Bureau. The use of a fictitious business name is subject to the provisions of

California Business and Professions Code Chapter 5 (commencing with section 17900) of Part 3 of Division 7. This Chapter defines fictitious names

and contains provisions regarding use and requirements for filing a statement with the local county clerk.

Private Patrol Operator: Business and Professions Code section 7582.17 states in part:

The Bureau shall not authorize the use of a fictitious or other business name which is so similar to that of a public office or agency of that used

by another licensee that the public may be confused or misled thereby.

* The Bureau must maintain a physical address of record on file at all times. If mail delivery to the physical location of the business is not possible,

please list a mailing address in addition to the physical business address. If you are operating out of your residence and wish to keep your physical

address confidential from public record, please submit a written request and attach it with this form.

1. Name of Qualified Manager

2. *Physical Business Address – Number and Street City State Zip Code

3. *Mailing Address (If applicable) City State Zip Code

4. Telephone Number Residence ( ) Business ( )

5. List proposed business names in the order of preference. At least three choices should be provided if a fictitious name is requested; however,

five choices are preferable. If the first name listed is approved, additional names will not be considered. Other criteria for name approval:

• If initials are to be used as part of the name, you must explain what they stand for.

• The use of the following words will not be approved for an individual or partnership license: Corporation, Corp., Incorporated, Inc.

• The following words or initials will not be approved as part of a

fictitious or business name: U.S., United States, Federal, State,

Bureau, Police, Task Force, Community, County.

1. __________________________________________________________

2. __________________________________________________________

3. __________________________________________________________

4. __________________________________________________________

5. __________________________________________________________

Department Use Only

Approved

Disapproved

6. CERTIFICATION:

If type of license is individual, the owner must sign.

If type of license is a partnership, all partners must sign.

If type of license is a corporation, a responsible corporate officer must sign.

I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Signature__________________________________________________ Title ______________________________ Date _____________________

14 31A-12 (Rev. 07/2020)