CITY OF FAIRBANKS
SECURITY GUARD LICENSE APPLICATION
FGC Section 14.31-40
APPLICATION REQUIREMENTS
□ Fee: New License and application (valid for 1 year) 480.00
Renewal License and application (valid for 1years) 340.00
□ Type of license: (circle one) Security Guard or Security Guard Business
□ Copy of your current State of Alaska driver’s license OR State of Alaska ID
□ $5000.00 surety bond
□ Criminal History Report must reflect a ten year history. Report for Alaska (APSIN) may be
obtained from the Alaska State Troopers, other states please contact that state’s Department of
Public Safety. NOTE: All reports must be current, APSIN report must be dated the same date
that the completed application is submitted to the City Clerk’s Office.
IF YOUR HISTORY DOES NOT REFLECT TEN YEARS,
YOU MUST ALSO PROVIDE THE FOLLOWING ITEM
□ Background check from states you resided in other than Alaska
□ Three affidavits signed and notarized (see page 3 of application)
□ Completed Application
ALL REQUIREMENTS MUST BE SUBMITTED WITH APPLICATION
Name: First______Middle______Last______
Other Names Used: ______
Current Address (Physical):______
Address (Mailing): ______ZIP ______
HM Phone #: ______Alt. Phone #: ______Email:______
Length of Time in Alaska: ______Years ______Months
Previous City and State other than Alaska for the past 10 years:
______City and State ______Years and Months
______City and State ______Years and Months
______City and State ______Years and Months
Sex: _____ Race:______Hair Color :_____ Eye Color: _____ Height: ____
Weight: ____ Glasses:Y / N Place of Birth:______Date of Birth______
BUSINESS:
Complete Name:______
Physical Address and Location______
______
Mailing Address______ZIP______
Phone #: ______Alt. Phone #: ______Fax #: ______
Email:______AK Business License # ______
EMPLOYMENT HISTORY for past 5 (five) years: (Attach additional sheet if necessary)
From / To
Employer______Dates Employed______
City/State______
Employer______Dates Employed______
City/State______
Employer______Dates Employed______
City/State______
Have you ever been? YES NO
Arrested and convicted of a crime? Ž
Convicted of a felony or misdemeanor involving moral turpitude? Ž Ž
Explain all “yes” answers on a separate sheet of paper, including charges, places, dates, and sentences imposed.
Please Note: An answer of YES to any of the above is grounds for denial of a Security Guard License by the City Clerk as per the City of Fairbanks Code of Ordinances Section 14-32.
APPLICANT’S STATEMENT FOR SECURITY GUARD LICENSE:
I, ______, being first duly sworn, depose and state that I am the individual making application for license and that the answers to the foregoing questions and other statements contained herein are true and complete to the best of my knowledge and belief. I understand that any materially false statement on this application may be subject to revocation or denial of license.
uI certify that I am 18 years of age or older.
uI certify that I have not been convicted of a felony or misdemeanor involving moral turpitude.
uI certify that I have read and understand the FGC 14.31-40
uI certify that I have read the application and understand the requirements for licensure.
______
Signature of Applicant
(SEAL)
Sworn to before me this ______
Day of ______, 20___.
______
NOTARY PUBLIC
My commission expires______.
The City Clerk’s office located at 800 Cushman Street, Fairbanks Alaska 99701 is open 9:00 am to 4:00 pm, Monday-Friday
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
ADMINISTRATIVE USE ONLY: ¨Approved ¨Disapproved. Reason: ______
Signature:______Date: ______
Title: City Clerk or Deputy City Clerk
AFFIDAVIT
I, ______, do swear and affirm that I have personally known ______(Applicant) for at least five (5) years, and believe he/she is competent, honest, of good moral character, and is suitable to engage in a Security Guard business to the best of my knowledge and belief.
______Signature
(SEAL) ______
Address
Sworn to before me this _____day
of______, 20___
______
NOTARY PUBLIC
My commission expires______.
AFFIDAVIT
I, ______, do swear and affirm that I have personally known ______(Applicant) for at least five (5) years, and believe he/she is competent, honest, of good moral character, and is suitable to engage in a Security Guard business to the best of my knowledge and belief.
______Signature
(SEAL) ______
Address
Sworn to before me this _____day
of______, 20___
______
NOTARY PUBLIC
My commission expires______.
AFFIDAVIT
I, ______, do swear and affirm that I have personally known ______(Applicant) for at least five (5) years, and believe he/she is competent, honest, of good moral character, and is suitable to engage in a Security Guard business to the best of my knowledge and belief.
______Signature
(SEAL) ______
Address
Sworn to before me this _____day
of______, 20___
______
NOTARY PUBLIC
My commission expires______.
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