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DOS 1587-f-a (Rev. 01/19) Page 1 of 9

New York State

Department of State

Division of Licensing Services

P.O. Box 22001

Albany, NY 12201-2001

Customer Service: (518) 474-4429

www.dos.ny.gov

Busines

s of Installing, Servicing or Maintaining Security or Fire Alarm Systems

Read ALL instructions carefully before completing the application.

Incomplete forms will be returned. Any omission, inaccuracy or

failure to make full disclosure may be deemed sufficient reason to

deny a license/registration or may result in the suspension or

revocation of an issued license/registration.

What is a Security or Fire Alarm Installer?

New York State law (Article 6D of the General Business Law) and

Department of State rules (19 NYCRR) defines a security or fire

alarm installer as one who installs, services or maintains security or

fire alarm systems to detect intrusion, break-in, movement, sound or

fire.

Who is excluded from this law?

A license is not required to install systems on motor vehicles, boats

or airplanes. A license is not required to install a battery operated

smoke detection device. However, a person who is in the business of

installing a hard wired smoke detector must be licensed.

Home or business owners installing a system on their own property

are not “in the business of” installing, and thus are not required to be

licensed.

It is important to note that such systems include only those dedicated

to detection. In the context of alarm systems, detection means to

warn or to notify. Therefore, the installation of “passive” (i.e., non-

detecting) security devices does not require licensure.

What are the qualifications for licensure?

All applicants must be at least 18 years of age at the time of

application.

You can qualify for licensure under one of the following methods:

Examination and Edu

cation

Experience and Education

C. Master

Electrician Waiv

Examination and Education: If you are new to the industry

u must pass a written exam and complete the required

education. For specific education requirements, see the next

page of these instructions. This examination is admi

nistered on a

wal

k-in basis and is taken PRIOR to the submission of an

application.

If you fail the examination, you will be mailed a notification

which you may use for readmission to another examination.

Once you pass the examination, you will be sent

a PASSED

otification. In order to complete the license process, you mu

subm

it:

— The completed, signed application;

— Applicable application fee payable to the NYS Department

of State;

— Your PASSED notifi

cation;

— Receipt that provides proof of electronic fingerpri

nting by

an approved vendor;

— Evidence of completion of education requirements (submit

all completion certificates);

— Any additional documentation requested in response to

specific questions on the application form.

B) E

xperience and Education: If you have at least two years of

experience in installing, servicing or maintaining security or fi

alarm systems, (totaling 3,500 working hours [equivalent to 35

hours per week for 100 weeks] that was obtained in New York

State between October 1, 1989 and September 30, 1992), you

may q

ualify for licensure without an exam. If you apply based

on this method, you must subm

it:

— The completed, signed application;

— Applicable application fee payable to the NYS Department

of State;

— Proof of experience as described above (submit all

completion certificates);

— Evidence of completion of education requirements (Submit

all completion certificates);

— Receipt that provides proof of electronic fingerprinting by

an approved vendor.

C) Master

Electrician Waiver: Individuals licensed as ma

ster

electrician

s who wish to engage in the installation, servicing,

main

taining of security or fire alarm systems are not exem

pted

om filing with the Department of State. However, two form

s of

waive

r from some of the specific licensing requirements (by

virtue of your status as a licensed master electrician) ar

available.

Statewide Lic

ense: Master El

ectricians who wish to practice

out

side their licensing jurisdiction(s), must be licensed by th

Depa

rtment of State. By virtue of your license as master

electrician, you are waived from the education, experience

and

exami

nation requirements. If you file based on this method, you

must submit

— The completed, signed application;

— Applicable application fee payable to the NYS Department

of State;

— Receipt that provides proof of electronic fingerprinting by

an approved vendor;

— List of jurisdictions in which you are licensed as a Master

Electrician (Please refer to and complete attachment A);

— A copy of your current Master Electrician license(s).

Registration within Local Jurisdictions Only:

Licensed Master Electricians who wish to only practice in their

local jurisdiction(s) must be registered with the Department of

State. By virtue of your license as a master electrician, all

licensing requirements, including the submission of fingerprints

are waived. Note: Those alarm installers designated “local”

may only engage in the alarm installer business in

municipalities where they are licensed as master electricians.

If you file based on this method, you must submit:

Business of Installing, Servicing or Maintaining Security or Fire Alarm Systems

DOS 1587-f-a (Rev. 01/19)

— The completed, signed application;

— Applicable application fee payable to the NYS Department

of State;

— List of jurisdictions in which you are licensed as a master

electrician (Please refer to and complete attachment A);

— A copy of your current Master Electrician license(s).

What are the education requirements?

License candidates are required by law to submit evidence of

education which demonstrates sufficient training in installing,

servicing, or maintaining of security or fire alarm systems. This

requirement may be satisfied by any of the following methods:

Successful completion of a minimum of 81 hours of course

study which is approved or recognized by the Department of

State as established by the department’s qualifying course

regulations.

Successful completion of industry sponsored training courses or

programs which are approved or recognized by the Department

of State as meeting educational standards in the field of security

or fire alarm systems.

Completion of various courses and industry sponsored training

programs which have not been approved or recognized by the

Department of State prior to January 1, 1993.

In order to receive full credit for these courses and training

programs, the subject matter must cover all facets of the field of

security or fire alarms which include but are not limited to the

following:

Basic Electricity: All Standards and Codes: National, NY

State Fire Prevention and Building Code, UL, NFPA, FM:

Control Devices; Alarm Communications; Motion

Detection; Perimeter Systems; Job planning; Fire Detection

Systems; Life Safety and Troubleshooting, Service and

Maintenance of Alarm Systems.

Licensing Services will evaluate this information and, when

applicable, issue credit in 15 or 21 hour blocks (modules) toward

meeting the 81 hour requirement.

What if I completed my education outside of

New York State?

We may waive the 81 hour Security & Fire Alarm Installer education

requirement if you can document an equivalent level of schooling.

You must submit the following documents:

An official transcript from the accredited college or uni

versity

ndicating satisfactory completion of the course(s) you woul

lik

e us to consider, or an original Certificate of Cour

Com

pletion from a recognized Security & Fire Alarm

Installer

sch

ool.

- An official description of the subject matter. This can usually

obt

ained from a school catalogue.

Send these, along with a letter requesting a waiver of the

qualifying education requirements to:

Department of State

Division of Licensing Services

Bureau of Educational Standards

PO Box 22001

Albany, NY 12201-2001

What if I have a secondary business location

(a/k/a branch office)?

In accordance with §195.5 of the Department’s rules and regulations

(19 NYCRR), a photocopy of the business license issued to your

principal location must be conspicuously displayed at each secondary

location of the business. You must file with the Department of State,

by registered or certified mail, the location of all secondary locations,

within five business days of their opening. If you are intending to

open secondary locations at this time, you must complete Attachment

C and submit it with this application.

Do I need to maintain a list of secondary

business locations?

Yes. In accordance with §195.5 of the Department’s rules and

regulations (19 NYCRR), a current list of all secondary locations is

to be maintained at the principal business location.

What are the application fees and terms of

licensure?

The nonrefundable application fees are as follows:

Examination and Education:

$185 - Application fee

$15 - Written exam fee

$100 - Renewal fee, every two years

$60 – Late fee, if renewal is received one year after expiration

Experience and Education:

$200 - Application fee

$100 - Renewal fee, every two years

$60 – Late fee, if renewal is received one year after expiration

Master Electrician - Statewide:

$200 - Application fee

$100 - Renewal fee, every two years

$60 – Late fee, if renewal is received one year after expiration

Master Electrician - Local Only:

$50 - Application fee

$50 - Renewal fee, every two years

$60 – Late fee, if renewal is received one year after expiration

How do I add or replace a qualifier on an

existing license?

To add an additional qualifier, check the appropriate box on page 2

of the application and submit a letter signed by the existing qualifier

approving the addition.

To replace an existing qualifier, check the appropriate box on page 2

of the application and submit a letter of resignation signed by the

existing qualifier.

I am intending to employ staff to assist in the

installation, servicing, or maintaining of security

or fire alarm systems. What do I need to do?

You must submit:

— The completed, signed, Employee’s Statement;

— Receipt that provides proof of electronic fingerprinting by

an approved vendor.

Page 2 of 9

Business of Installing, Servicing or Maintaining Security or Fire Alarm Systems

DOS 1587-f-a (Rev. 01/19)

e 3 of 9

What forms of payment do you accept?

You may pay by check or money order made payable to the

Department of State or by MasterCard or Visa, using a Credit Card

Authorization form www.dos.ny.gov/forms/licensing/1450-f-a.pdf .

Do not send cash. Application fees are non-refundable. A $20 fee

will be charged for any check returned by your bank.

FINGERPRINT REQUIREMENTS:

Applicants have access to electronic fingerprinting through IdentoGo

by IDEMIA.

Electronic Fingerprinting Procedure:

Applicants must schedule appointments with IdentoGo by IDEMIA.

To schedule an appointment at a location near you, visit their website

at www.identogo.com or call 877-472-6915. For scheduling

purposes, you must utilize the required Service Code 1545SG. The

Alarm Installer Employee Service Code is 1545TY. Failure to use

the correct license type or Service Code may result in the need to be

reprinted.

What to bring to Appointment: Approved and acceptable form of

identification (for a list, please visit www.dos.ny.gov/licensing

/fingerprinting.html), along with an acceptable form of payment.

Proof of electronic fingerprint completion: Upon completion of the

fingerprint process, the vendor will provide you with two receipts as

proof of fingerprint completion. Include one receipt with the

completed application. The second copy of the receipt should be

retained by your employer.

PLEASE NOTE: Fingerprint receipts are valid for 5 months from

the date of fingerprinting. Please submit original application within 5

months from the date of fingerprinting. Failure to submit your

application within this time period will require you to complete the

fingerprint process again.

Fingerprint fees:

Payment for fingerprint fees must be made in the form of a check,

money order or credit card payment payable to IDEMIA.

Division of Criminal Justice Services (DCJS) fee: $75.00 plus

applicable fingerprint vendor fee (subject to change in January and

July of each year) See “e-Fingerprinting” link on top right at

www.dos.ny.gov/licensing.

Note: fingerprint fees are in addition to the application fee.

Child Support Statement:

A Child Support Statement is mandatory in New York State (General

Obligation Law) regardless of whether or not you have children or

any support obligation. Any person who is four months or more in

arrears in child support may be subject to having his or her

business, professional or driver’s licenses suspended. The

intentional submission of a false written statement for the purpose of

frustrating or defeating the lawful enforcement of support obligations

is punishable under §175.35 of the Penal Law. It is a class E felony

to offer a false instrument for filing with a state or local government

with the intent to defraud.

PRIVACY NOTIFICATION

Do I need to provide my Social Security and federal

ID numbers on the application?

Yes, if you have a social security number or Federal ID number, you

are required to provide this number. If you do not have a social

security number or Federal ID number, please provide a written

explanation.

The Department of State is required to collect the federal Social

Security and Employer Identification numbers of all licensees. The

authority to request and maintain such personal information is found

in §5 of the Tax Law and §3-503 of the General Obligations Law.

Disclosure by you is mandatory. The information is collected to

enable the Department of Taxation and Finance to identify

individuals, businesses and others who have been delinquent in filing

tax returns or may have underestimated their tax liabilities and to

generally identify persons affected by the taxes administered by the

Commissioner of Taxation and Finance. It will be used for tax

administration purposes and any other purpose authorized by the Tax

Law and may also be used by child support enforcement agencies or

their authorized representatives of this or other states established

pursuant to Title IV-D of the Social Security Act, to establish,

modify or enforce an order of support, but will not be available to the

public. A written explanation is required where no number is

provided. This information will be maintained in the Licensing

Information System by the Director of Administration and

Management, at One Commerce Plaza, 99 Washington Avenue,

Albany, NY 12231-0001.

WOULD YOU LIKE TO REGISTER TO VOTE?

Please visit the NY State Board of Elections at www.elections.ny.gov/votingregister.html

or call 1-800-FOR-VOTE to request a NYS Voter Registration form.

To register online, please visit www.ny.gov/services/register-vote.

DOS-1587-f-a (Rev. 01/19)

Page 4 of 9

FOR OFFICE UNIQUE ID NUMBER FEE CASH NUMBER

USE ONLY

___

LICENSE/REGISTRATION

TERM

___

— |

___

New York State

Department of State

Division of Licensing Services

P.O. Box 22001

Albany, NY 12201-2001

Customer Service: (518) 474-4429

www.dos.ny.gov

Business

Installing, Servicing

Maintaining

Security or Fire Alarm

Sys

tems

TYPE OR PRINT CLEARLY. Illegible applications will be returned for clarification, causing delays in licensure.

➠ APPLICATION AS Examination and Education Experience and Education (obtained in New York State

(CHECK ONE) - $185 Application Fee between October 1, 1989 and September 30, 1992)

- $200 Application Fee

Master Electrician Statewide Master Electrician Local Only

- $200 Application Fee - $50 Application Fee (no fingerprint requirement)

Place an X in

ONE of the license types listed on this page:

I am applying as:

I am the principal/owner/officer, or

a qualifying manager or member, and

affirm the below business is filed with the

Office of the County Clerk

I am the principal/owner/officer, or

a qualifying manager or member, and affirm

the below business is filed with the

Division of Corporations

Trade Name Limited Liability Company or Limited Partnership

(conducts business as a sole (conducts business under the Limited Liability,

Proprietorship, doing business as a Limited Partnership or Assumed Name)

Name other than his or her own name)

Partnership Corporation

(conducts business under the partnership name) (conducts business under the corporate name or assumed name only)

Individual

(conducts business using his or her personal name only)

APPLICANT INFORMATION * required responses

LAST NAME * FIRST NAME * MIDDLE INITIAL SUFFIX

APPLICANT’S HOME ADDRESS NUMBER AND STREET (PO BOX MAY BE ADDED TO ENSURE DELIVERY) *

CITY * STATE * ZIP+4 * COUNTY *

TELEPHONE NUMBER SOCIAL SECURITY NUMBER FEDERAL ID NUMBER (SEE PRIVACY NOTIFICATION)

( )

E-MAIL ADDRESS - IF ANY DATE OF BIRTH

Business of Installing, Servicing or Maintaining Security or Fire Alarm Systems

DOS-1587-f-a (Rev. 01/19)

Page 5 of 9

BUSINESS INFORMATION * required responses

To add or replace a qualifier on an existing license, check appropriate box below and provide the UID# in the space provided.

I am applying as: an additional qualifier OR replacing the current qualifier on an existing license.

UID# ___________________________ (Additional documentation must be submitted; see application instructions)

BUSINESS NAME *

BUSINESS ADDRESS NUMBER AND STREET (PO BOX MAY BE ADDED TO ENSURE DELIVERY) *

CITY * STATE * ZIP+4 * COUNTY *

BACKGROUND

QUESTIONS

1. Have you ever been convicted of a crime that is a misdemeanor or felony? * YES NO

➔IF “YES,” you must submit a written explanation and provide a copy of the court records detailing the

allegations of the offense and how the case was resolved. If you have received a Certificate of Relief

from Disabilities, Certificate of Good Conduct or Executive Pardon, you must submit a copy with this

application.

2. Are there any criminal charges (misdemeanor or felonies) pending against you in any court? * YES NO

➔IF “YES,” you must submit a written explanation and provide a copy of the court records detailing the

allegations of the offense.

3. Has any license or permit issued to you or a company in which you are or were a principal ever been revoked,

suspended or denied? * YES NO

➔IF “YES,” you must provide all relevant documents, including the agency determination if any.

4. Have you ever applied for or been issued a Security or Fire Alarm System Installer’s license or occupational

license of any type? YES NO

➔IF “YES,” you must provide the UID#.

Child

Support Statement

By signing this application, I certify that as of the date of this application, I am not under an obligation to pay child support OR if I am

under an obligation to pay child support, I am not four or more months in arrears in the payment of child support, or I am making payments

by income execution or by court agreed payment or repayment plan or by plan agreed to by the parties or my child support obligation is

the subject of a pending court proceeding, or I am receiving public assistance or supplemental security income.

Applicant Affirmation — I affirm that I have read and understand the provisions of Article 6D of the General

Business Law and the rules and regulations promulgated thereunder (19 N YC RR). I further affirm that Workers’ Compensation

Insurance/Disability Benefits, for all employees, if applicable, has been secured. I further certify, under the penalties of perjury,

that the information given above is true to the best of my knowledge and belief. I understand that any material misstatement

made may result in the revocation or suspension of the license, if issued.

Applicant’s Signature D a te

Print Name

Please

remember

to include with your

application

any

required

documentation along

with the applicable fees.

It is important that you notify this division of any changes to your address so you will receive renewal

notices and any other notifications pertinent to your license/registration.

DOS-1587-f-a (Rev. 01/19)

Page 6 of 9

Business of Installing, Servicing or Maintaining Security or Fire Alarm Systems

Master Electrician:

List of

risdictions

I am a Master Electrician and have listed below the jurisdictions and license numbers in

which I am licensed as a Master Electrician and have included a copy of my current

Master Electrician license(s).

Name and address(es) of

jurisdiction(s)

where you are

licensed

License No. Exp.

Date

Business of Installing, Servicing or Maintaining Security or Fire Alarm Systems

DOS-1587-f-a (Rev. 01/19)

Page 7 of 9

Experience in NYS

Form 10/1/19

89 – 9/3/1992

You are to have at least 2 years of experience in installing, servicing, or maintaining security or fire alarm systems (totaling

3,500 working hours [equivalent to 35 hours per week for 100 weeks] that was obtained in New York State between October

1, 1989 and September 30, 1992). PRINT or TYPE below in blue or black INK a complete record of your occupation(s) during

the time period which your qualifying experience is claimed. Include the name, address, and telephone number of each

employer and dates of employment. You may copy this page and attach as many sheets as needed. You may be asked to

provide proof of your experience. NOTE: Failure to provide adequate proof of experience upon request may be

grounds for denial of this application.

NAME OF COMPANY

COMPANY ADDRESS

EMPLOYMENT STATUS FULL-TIME PART-TIME HOURS PER WEEK DATE OF EMPLOYMENT FROM/TO

SUPERVISOR

BUSINESS TELEPHONE

POSITION/TITLE (Attach a Separate Sheet Explaining Your Duties) NATURE OF BUSINESS

NAME OF COMPANY

COMPANY ADDRESS

EMPLOYMENT STATUS FULL-TIME PART-TIME HOURS PER WEEK DATE OF EMPLOYMENT FROM/TO

SUPERVISOR

BUSINESS TELEPHONE

POSITION/TITLE (Attach a Separate Sheet Explaining Your Duties) NATURE OF BUSINESS

NAME OF COMPANY

COMPANY ADDRESS

EMPLOYMENT STATUS FULL-TIME PART-TIME HOURS PER WEEK DATE OF EMPLOYMENT FROM/TO

SUPERVISOR

BUSINESS TELEPHONE

POSITION/TITLE (Attach a Separate Sheet Explaining Your Duties) NATURE OF BUSINESS

Business of Installing, Servicing or Maintaining Security or Fire Alarm Systems

DOS 1587-f-a (Rev. 01/19)

Page 8 of 9

PAGE ____ OF ____

BRANCH LOCATIONS

Using the following format, type or print below the complete address for each branch office in New York State.

You may photocopy this sheet as many times as needed to list every office.

STREET ADDRESS Apt/Fl/Ste CITY STATE ZIP CODE

Business of Installing, Servicing or Maintaining Security or Fire Alarm Systems

DOS 1587-f-a (Rev. 01/19) Page 9 of 9

A COMPLETED APPLICATION MUST INCLUDE:

(Use this checklist to ensure you have included/completed all requirements)

You must complete all required * responses.

If you do not complete all required responses, your application will be returned.

Page 4

You must check one box in the section “Application as” and one box in the section "I am applying as."

Applicant Information:

Complete "Applicant Information" required (*) responses.

Business Information:

To add or replace a qualifier on an existing license, check appropriate box and provide the UID# in the space provided.

Complete "Business Information" required (*) responses.

Business Name: Clearly print or type the business name under which you will conduct business (as it appears on the filing receipt or

business certificate). Individual applicants should complete this section with first name; middle initial; last name (if applicable)

Business Address: All applicants MUST provide a business address.

Page 5

Background Questions: If you answered YES to questions 1, 2 or 3:

Question #1 - court documentation which MUST be submitted: A copy of the certificate of disposition from the court AND a copy of

the accusatory instrument * from the court.

Question #2 - court documentation which MUST be submitted: A copy of the accusatory instrument * from the court AND

adjournment notice(s) indicating future court date(s) from the court.

Question #3 - you must provide all relevant documents, including the agency determination, (if any).

* An accusatory instrument is a document that is used by prosecutors and the criminal courts to charge and prosecute someone

accused of a crime(s) and details the facts and circumstances surrounding the crime(s). This could be an Indictment, Superior

Court Information, Criminal Complaint, etc.

Child Support Statement: (read)

Applicant Affirmation:

Sign and print your name and date the application.

Page 6

Attachment A – Master Electrician Jurisdiction list

Print or type the name and address of jurisdiction where you are licensed. Attach a copy of your license.

Page 7

Attachment B – Experience in NYS from 10/1/1989 – 9/3/1992

Print or type employment information for claimed experience.

Page 8

Attachment C – Branch Locations

Print or type all branch locations complete street addresses.

Additional Items to be submitted with your application

Examination Slip:

Attach the yellow copy of your passed exam notification (cannot be more than 2 years old).

Receipt of electronic fingerprinting:

Attach 1 copy of the receipt provided by the vendor.

Application Fee:

Fees are payable to the NYS Department of State. (see instructions for acceptable payment methods).

Become an Organ and Tissue Donor

Organ donors save lives. If you would like to be an organ and tissue donor upon your death, you may enroll in the

NYS Donate Life Registry online at www.donatelife.ny.gov/register or complete the form below. Completed forms

should be sent to the NYS Donate Life Registry by email --- [email protected] or, mail - NYS Donate Life

Registry, 185 Jordon Road, Troy, NY 12180.

Fields with an asterisk (*) are required for enrollment. Upon receipt of your completed enrollment form, you will be

sent an email or letter confirming your enrollment and providing you with information on how to limit your donation.

I understand that by opting out of enrolling in the NYS Donate Life Registry, or skipping this question, will not impact

or impair my ability to obtain services from the New York Department of State, Division of Licensing Services.

*Last name

*First name

Middle Initial Suffix

*Address

*Apt. Number *Zip Code

*City

*Birth date / / *Gender M

MM DD YYYY

Email address

DMV or IDNYC Number

By signing below, you certify that you are:

• 16 years of age or older;

• Consenting to donate your organs and tissues for

transplantation and/or research in the event of your death;

• Authorizing the New York Department of State, Division of

Licensing Services to transfer your name and identifying

information to the NYS Donate Life Registry for

enrollment;

and

• Authorizing the Registry to give access to this information

to federally regulated organ procurement organizations

and NYS-licensed tissue and eye banks and others

approved by the NYS Commissioner of Health in the event

of your death.

*Sign *Date