Application for Security Alarm System Contractor or Security Guard Agency License or Relicensure

FOR OFFICE USE ONLY

FEE PAYMENT INFORMATION (Check One Box)

CSCL/LSA-010 (10/19)

Page 1 of 2

Corporations, Securities & Commercial Licensing

Licensing Division

P.O. Box 30018, Lansing, MI 48909

517-241-9221

www.michigan.gov/securityalarm

www.michigan.gov/securityguard

Make your check or money order in U.S. Currency payable to:

STATE OF MICHIGAN

FEES ARE AUTHORIZED UNDER 1968 PA 330

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with

disabilities.

Business Address City

State Zip Code

Company Name

Telephone Number

E-mail Address

APPLICATION FOR SECURITY ALARM SYSTEM CONTRACTOR OR

SECURITY GUARD AGENCY LICENSE OR RELICENSURE

AUTHORITY: 1968 PA 330, MCL 338.3434a, AND 42 USC 654

PENALTY: FAILURE TO PROVIDE THIS INFORMATION MAY RESULT IN DENIAL OF THE APPLICATION AND/OR DISCIPLINARY ACTION.

Permanent ID# (if applicable)

$300.00

Company License

3801-01

$200.00

Individual License (Sole Proprietor)

3801-01

Security Guard Agency

Security Guard Agency Relicensure

$200.00

3801-06

Individual License (Sole Proprietor)

$300.00Company License 3801-06

FOR OFFICE USE ONLY

Have you ever been adjudged insane? Yes No If yes, have you been restored to sanity by court order? Yes No

Do you have any outstanding warrants for your arrest?

Yes No

Have you ever been convicted of a felony not previously reported to the Department for this license type or occupation?

NoYes

Have you ever been convicted of a misdemeanor within 5 years involving any of the following before the date of this application?

(dishonesty or fraud, unauthorized divulging or selling of information or evidence, impersonation of a law enforcement officer or employee of

the United States, this state or a political subdivision of this state, illegally using, carrying, or possessing a dangerous weapon, two or more

alcohol related offenses, controlled substances under the public health code, 1978 PA 368, MCL 338.1101 to 333.25211 or assault.

Do you have a high school diploma or its equivalent?

NoYes

Did you serve in the armed forces and act as a military police officer or in an equivalent job classification for at least 2 years?

NoYes

Name (First, Middle, Last) US Social Security NumberDate of Birth

$500.00 3601-01Security Alarm System Contractor

Fee WaivedNew Individual Applicant - Veteran

(see required additional documentation)

Fee WaivedNew Individual Applicant - Veteran

(see required additional documentation)

$500.00 3601-06Security Alarm System Contractor

Relicensure

Approved By:

Date Approved:

License Number

Yes No

CSCL/LSA-010 (10/19)

Page 2 of 2

QUALIFYING EXPERIENCE INFORMATION

If you are applying for private security guard agency license, you must meet one of the following: (check all that apply)

(i) Was engaged in the private security guard or agency business on his or her own account in another state for a period of at least 3 years.

(ii) Was engaged in the private security

guard or agency business for a period of at least 4 years as an employee of the holder of a certificate of

authority to conduct a private security guard or agency business and has experience reasonably equivalent to at least 4 years of full-time guard work in

a supervisory capacity with rank above that of patrolman.

(iii) Was employed in law enforcement as a certified police officer on a full-time basis for at least 4 years for a city, county, or state government or for

the United States government.

(iv) Was engaged in the private security guard or agency business as an employee or on his or her own account or as a security administrator in private

business for at least 2 years on a full-time basis, and is a graduate with a baccalaureate degree or its equivalent in the field of police administration or

industrial security from an accredited college or university.

(v) While on active duty as a member of the armed forces, served as a military police officer or in an equivalent job classification for at least 2 years;

was

honorable character of service or under honorable conditions (general) character of service from that military service; and provides with his or her

application an affidavit signed by a commanding officer, supervisor, or military superior with direct knowledge of the applicant's service that he or she

has, entry-level experience in

or basic knowledge of each of the following:

(A) Enforcing rules, regulations, and guidelines.

(B) Providing security and physical protection.

(D) Overseeing prisoners and correctional facilities

(E) Reconnaissance and surveillance.

If you are applying for a security alarm system contractor license, you must have been lawfully engaged in either or both of the following: (check all that

apply)

A security alarm system contractor business on his or her own account for a period of not less than 3 years.

A security alarm system contractor business for a period of not less than 4 years as an employee of the holder of a certificate of authority to conduct a

security alarm system contractor business, and have experience reasonably equivalent to at least 4 years of full-time work in a supervisory capacity.

I do not have experience equivalent to at least 4 years of full-time work in a supervisory capacity. (The Department will notify you authorizing you to

to take the exam).

Additional Required Documents

Signature

Date

City

Print Name

APPROVAL COUNTY SHERIFF OR CITY CHIEF OF POLICE WHERE PRINCIPAL OFFICE LOCATED - Required per MCL 338.1057(3)

Signature Date

Title (Sheriff or City Chief of Police)

County

APPROVAL COUNTY PROSECUTING ATTORNEY WHERE PRINCIPAL OFFICE LOCATED - Required per MCL 338.1057(3)

City

Print Name

Signature

Date

County

Title

Certification:

I certify that the statements in this document are true and complete. I understand that any omitted statement, misrepresentation, or fraud may be cause for

denial of my application, disciplinary action, or may be punishable by law. I agree the Department is required by

law to obtain my social security number

pursuant to MCL 338.3434a.

 5 reference statements pursuant to MCL 338.1057(1)

 2 passport quality photos of individual or of the resident manager if a business pursuant to MCL 338.1058(2)

 Surety bond or certificate of insurance pursuant to MCL 338.1059(1)

 Certificate of incorporation of business, if applicable

 If requesting a fee waiver as an individual who served in the armed forces - form DD214, DD215, or any other form acceptable to the Department that

demonstrates you were separated from service with an honorable character of service or under honorable conditions (general) character of service.

 If you are using your experience in the military as qualification for licensure, you must also submit the documentation listed above along with an affidavit

signed by a commanding officer, supervisor or military superior with direct knowledge of your service and that you have entry-level experience in or basic

knowledge of each of the items listed in MCL 338.1056(1)(g)(v).