STATE OF CALIFORNIABUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY GOVERNOR EDMUND G. BROWN JR.

BUREAU OF SECURITY AND INVESTIGATIVE SERVICES

P.O. Box 989002
West Sacramento, CA 95798-9002
(916) 322-4000 (800) 952-5210
Fax (916) 575-7290 www.bsis.ca.gov

APPLICATION FOR SECURITY GUARD REGISTRATION

ALL FEES ARE NON-REFUNDABLE
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 Veterans 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.

IMPORTANT INSTRUCTIONS: Read all instructions contained in this application, including information on the reverse side of this page.

PLEASE PRINT OR TYPE

Last

First

Middle

1. Name
Month Day

2. Social Security Number

3. Date of Birth

Number and Street

Year

City

/
State

Zip

4. Residence Address
(Optional)

5. Telephone

6. Email Address

7a. Have you ever been convicted of, or pled guilty or nolo contendere to ANY criminal or civil offense in the United
States, its territories, or a foreign country? This includes every citation, infraction, misdemeanor and/or felony. Convictions
that were adjudicated in the juvenile court or convictions under California Health and Safety Code sections 11357(b), (c), (d), (e)
or section 11360(b) which are two years or older, as well as criminal charges dismissed under section 1000.3 of the Penal Code
or equivalent non-California laws, should NOT be reported. Convictions that were later dismissed pursuant to sections 1203.4,
1203.4a, or 1203.41 of the California Penal Code or equivalent non-California law MUST be disclosed.
YES
NO

7b. Is any criminal action pending against you, or are you currently awaiting judgment and sentencing following entry of a
plea or jury verdict?
YES
NO
8. Have you ever been registered as a security guard?

NO

YES, enter license #:_____________________

IF EMPLOYED, PROVIDE EMPLOYER INFORMATION

Number

9. Employer Name

Expiration Date

10. Employer License #

Number and Street

City

State

13. First Day of Employment

Zip

11. Address
12. Telephone

PEACE OFFICER INFORMATION

14a. Are you a PEACE OFFICER holding peace officer status as defined by Chapter 4.5 (commencing with section 830)
of Title 3 of Part 2 of the Penal Code or a level I or level II reserve officer under paragraphs (1) and (2) of
subdivision (a) of section 832.6 of the Penal Code?
YES*
NO
*Refer to number 1 on the third page of this application for application filing requirements.
14b. I have attached a copy of proof of my successful completion of a course of study in the exercise of power to arrest.
(The course must be approved by the Commission on Peace Officer Standards and Training.)

Initial:

(Rev. 12/2014)

POWER TO ARREST COURSE CERTIFICATION

The Security Guard applicant must have completed the eight (8) hour "Power to Arrest" training including passage of the
examination. This training can be obtained from a Private Patrol Operator or a Bureau certified training facility or any
organization or school approved by the Bureau to teach the course.
15. I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA, that the
applicant has been instructed in the Power to Arrest and that he or she has passed with a score of 100%.
_______________________________________
INSTRUCTOR OR EMPLOYER SIGNATURE

_______________________________________________
TYPE OR PRINT NAME

____________________________________________________________________
SCHOOL OR BUSINESS NAME
_________________________
LICENSE EXPIRATION DATE

____________________________
LICENSE #

____________________________________________
CERTIFICATE OF COMPLETION SERIAL NUMBER
(

SCHOOL OR BUSINESS ADDRESS

CITY

STATE

ZIP CODE

PHONE NUMBER

16. I DECLARE UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE STATE OF CALIFORNIA, that all
statements on this application are true and correct, with full knowledge that all statements herein are subject to
investigation and that any false, dishonest, or incomplete answers to any questions on the application may be
grounds for denial or subsequent revocation of my registration and/or criminal prosecution.
Signature _______________________________________________________________
Date _____________________________
NOTE: You are eligible to work as a Security Guard only when you have in your possession a hard copy printout of the Bureau's approval obtained
from the Bureau's web site and a valid photo identification or a valid Security Guard registration.

The information on this application is requested pursuant to Business and Professions Code sections 114.5, 480, 7582.8,
7582.10, 7583.8, 7583.9 and 7583.10 and will be used to determine eligibility for registration.
Upon issuance of a permanent registration, you must notify the Bureau of any change of address within 30 days of the
change. If you do not, you may be assessed an administrative fine pursuant to section 7587.14. A registration shall not be
renewed until all fines assessed pursuant to section 7587.7, and not resolved in accordance with the provisions of the section,
have been paid.
Attention Applicants and Employers: Every person employed by a licensed Private Patrol Operator to provide the services
of a Security Guard must have a valid Security Guard registration or a screen printout of the Bureaus approval obtained from
the Bureau's web site.
Once the Bureau has issued the Security Guard registration, the information will appear on the Bureau's web site. The
Security Guard, Private Patrol Operator or training facility can verify the Bureau's approval by checking the Bureau's "Verify a
License" at http://www.bsis.ca.gov/online_services/verify_license.shtml. Once the Security Guard registration has been
cleared and appears on the Bureau's web site, a screen printout from the web site may be used as an interim Security Guard
registration and the Security Guard can be placed on assignment.
A Security Guard placed on assignment must have the following documents on his or her person when on duty:
1. A valid Security Guard registration or a screen printout of the Bureau's approval obtained from the Bureau's web site.
2. A valid driver's license or photo identification.
NOTE: Once registered, the Security Guard shall complete not less than 32 hours of training in security officer skills within six
months from the date the registration card is issued. Sixteen of the 32 hours shall be completed within 30 days from the date
the registration card is issued. (Business and Professions Code section 7583.6 (b))
Every Security Guard employed by a Private Patrol Operator or a Security Guard employed by a lawful business who carries
a firearm or baton, must possess a valid firearm or baton permit/certificate along with a valid Security Guard registration
issued by the Bureau.

(Rev. 12/2014)

INFORMATION ABOUT APPLICATION

SECURITY GUARD REGISTRATION
PLEASE FOLLOW THE STEPS BELOW:

1.

If you are a currently employed, full time peace officer holding peace officer status under Chapter 4.5, (commencing with
section 830) of Title 3 of Part 2 of the Penal Code, or a level I or level II reserve officer under paragraphs (1) and (2) of
subdivision (a) of Section 832.6 of the Penal Code and have completed a course of study in the exercise of the power to
arrest approved by the Commission on Peace Officer Standards and Training then you are not required to complete a Power
to Arrest course approved by the Bureau at a Bureau certified Training Facility. Furthermore, you are exempt from the live
scan requirement if you are only applying for a security guard registration. The exemption from the live scan requirement
DOES NOT extend to a security guard registration with firearm permit. Please include proof of successful completion of a
course of study in the exercise of the power to arrest and a front and back copy of your peace Officer ID or a letter from your
Commanding Officer, on you employing law enforcement agencys letterhead, certifying your peace officer status along with
the application for security guard registration. Do not complete the Power to Arrest Course Certification section if you
checked yes to the box indicating peace officer or level I or II reserve officer.

2.

Complete a Security Guard Live Scan form if you are only applying for a security guard registration. Complete a Security
Guard with Firearm Live Scan form if you are applying for a security guard registration and a firearm permit. Both live scan
forms can be downloaded from the Bureau's web site.

3.

With three copies of the completed Security Guard or Security Guard with Firearm Live Scan form, go to the nearest Live
Scan site to have your fingerprints electronically submitted to the Department of Justice (DOJ) and the Federal Bureau of
Investigation (FBI). Click here to locate a Live Scan site.

4.

Pay the Live Scan Operator. Live Scan Operator fees are set by each site and vary. The fees include the DOJ and FBI
fingerprint processing fees.

5.

Submit the following to the Bureau:

(a) The completed original Security Guard Registration application.
(b) The second copy of the Live Scan form signed by the Live Scan Operator, identifying the ATI number.
(c) A check or money order for $50.00 (Initial Security Guard Registration Fee).

Be sure to answer all questions on the application completely and truthfully. Any omission or false statement on the application
may constitute grounds for denial or subsequent revocation of the registration.
A registration may be denied to any person who makes a false statement or who has been convicted of any crime or act
substantially related to the functions or duties of a security guard. However, the Bureau will consider evidence of rehabilitation.
Pursuant to Business and Professions Code section 30, providing your social security 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 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, 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 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@dca.ca.gov. For questions about the Departments 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.