Welcome o he Prive Securiy Ceriicio d Licesig Progrm Ached you will id he pplicio or ew pplic, ddig ew ceriicio/licesure or upgrdig. Plese mke sure o complee i i is eirey. Icomplee or illegible orms/documes my dely issuce o ceriicio or licesure. For miimum sdrds (OAR 259-00-0020), procedures (OAR 259-00-0025) or geerl quesios plese reer o our websie hp://www.orego.gov/dpss/ps. ou my lso coc our oice hrough emil securiy.ivesigors@se.or.us or by cllig our oice : (503)378-8531. Impor iormio or ll pplics 1) Wh is required or compleed NEW pplicio pcke? PS-1 Applicio or ceriicio or licesure; PS- Compleio o required riig & miimum quliicios or pproprie level o ceriicio or licesure; PS-20 Temporry Work Permi (i currely employed); PS-27 Code o Ehics; Fees; d *Figerpris opios & iormio: hp://www.orego.gov/dpss/ps/pges/igerpriigio.spx *I usig Fieldpri, Ic. ou mus iclude copy o your Coirmio Pge wih your PS-1 upo submissio o DPSST. 2) Wh is required or compleed pplicio pcke whe ADDING ceriicio or licesure? PS-1 Applicio or ceriicio or licesure; PS- Compleio o required riig & miimum quliicios or pproprie level o ceriicio or licesure; PS-20 Temporry Work Permi (i currely employed); PS-27 Code o Ehics; d Fees I ddig Armed Proessiol ceriicio: Iclude PS-23 Chge o Iormio orm 3) Wh is required or compleed pplicio pcke whe UPGRADING rom Urmed o Armed Ceriicio? PS-1 Applicio or ceriicio or licesure; PS- Compleio o required riig & miimum quliicios; PS-23 Chge o Iormio; PS-27 Code o Ehics; d Fees 4) For Lis o Ceriied Prive Securiy Isrucors h c provide he riig or proessiol pplics, plese reer o he ollowig lik: hp://www.orego.gov/dpss/ps/docs/isrucorlis.pd Plese oe: A Ceriied Prive Securiy Isrucor will complee Triig Aidvi (PS-) oce you hve compleed your required riig. This orm is oly vlid i submied o he deprme wihi 180 dys o he riig compleio de. [OAR 259-00-000]. 5) For clss cledr or riig provided by DPSST o mgers d isrucors, plese reer o he ollowig lik: hp://www.orego.gov/dpss/ps/docs/psmgerisclssschedule.pd ) To check he sus o your pplicio, ccess IRIS vi he ollowig lik: hp://dpsse.se.or.us/iris_publiciquiry/privesecuriy/smsgoperso.spx 7) Temporry Work Permis (PS-20s) my be held or up o 120 dys. Addiiol PS-20 requess eed prior pprovl rom he deprme. PS-20 s will o be issued o Isrucors or o persos providig rmed prive securiy services. [OAR 259-00-0025] 8) Code o Ehics (PS-27) orm, irmig morl iess d proessiol sdrds is required o be se wih ll PS-1 pplicio merils. Applicios submied wihou his orm will geere deiciecy d dely issuce o ceriicio/licesure. 9) For he deiiio o Prive Securiy Services, see OAR 259-00-0010. 10) The deprme my dmiisrively ermie he pplicio process d ll ees pid will be oreied i he Deprme is uble o complee he ceriicio process due o o-respose, o-complice, upo he discovery o disquliyig crimil covicios or y violio o he emporry work permi provisios. 11) Pursu o OAR 259-00-0500 pymes o he Deprme re o-reudble. 12) All prive securiy providers mus oiy he Deprme wihi 14 cledr dys o y chge o ddress by compleig Prive Securiy Provider Chge o Iormio orm (PS-23), which c be oud o our websie. PS-1 Applicio or Ceriicio or Licesure Revised: 08/2015
Triig Requiremes & Fees PROFESSIONAL Ceriicio Reques: Triig Requiremes UNARMED Proessiol 14 hour UNARMED Bsic Clssroom/Exm (Ach PS-) $5 ALARM MONITOR Proessiol 12 hour ALARM MONITOR Bsic Clssroom/Exm (Ach PS-) $5 ARMED Proessiol 14 hour UNARMED Bsic Clssroom/Exm (Ach PS-); d $5 (Icludes Urmed Proessiol) 24 hour FIREARM Bsic Course (Ach PS-) INSTRUCTOR Ceriicio Reques: UNARMED Isrucor ALARM Moior Isrucor FIREARMS Isrucor MANAGER Licesure Reques: SUPERVISOR Mger EXECUTIVE Mger Triig Requiremes Ech pplic or isrucor ceriicio mus provide proo o 3 yers work experiece i prive securiy, lw eorceme, or miliry police 14 hour UNARMED Bsic Clssroom/Exm (Ach PS-); d UNARMED Prive Securiy Isrucor Course/Exm 12 hour ALARM MONITOR Bsic Clssroom/Exm (Ach PS-); d ALARM MONITOR Prive Securiy Isrucor Course/Exm 14 hour UNARMED Bsic Clssroom/Exm (Ach PS-); 24 hour Bsic FIREARMS Course (Ach PS-); Proo o compleio o riig rom pproved source wihi ive (5) yers o he de o pplicio (OAR 259-00-0135); d FIREARMS Prive Securiy Isrucor Course/Exm Addiiol Requiremes ~ Icludes proessiol ceriicio o exr chrge ~ (Idice proessiol ceriicio i Secio 1 o his pplicio) Bsic Clssroom/Exm or Proessiol Ceriicio (Ach PS-); d Mger Course/Exm Bsic Clssroom/Exm or Proessiol Ceriicio (Ach PS-); d Mger Course/Exm $90 $90 $158 Price icludes $8 rge ee $75 $250 FINGERPRINTS REQUIRED I pplyig or: Urmed, Armed/Urmed, Alrm Moior Ceriicio +$41.75 OR I ONL pplyig or: Isrucor Ceriicio or Mger Licesure +$42.75 TOTAL DUE: ~ Mus currely hold ceriicio or licesure or opios lised below ~ Figerpris re o required i upgrdig or ddig ceriicio or licesure UPGRADE Reques: Addiiol Requiremes PS-23 Chge o Iormio orm ARMED Proessiol 24 hour Bsic FIREARMS Course (Ach PS-) $20 ADDING Isrucor Ceriicio: Pre-requisie/Triig Requiremes Ech pplic or isrucor ceriicio mus provide proo o 3 yers work experiece i prive securiy, lw eorceme, or miliry police UNARMED Isrucor UNARMED Prive Securiy Isrucor Course/Exm $90 ALARM Moior Isrucor ALARM MONITOR Prive Securiy Isrucor Course/Exm $90 FIREARMS Isrucor ADDING Mger Licesure: Proo o compleio o riig rom pproved source wihi ive (5) yers o he de o pplicio (OAR 259-00-0135); d FIREARMS Prive Securiy Isrucor Course/Exm Triig Requiremes PS-1 Applicio or Ceriicio or Licesure Revised: 08/2015 FEE $158 Price icludes $8 rge ee SUPERVISOR Mger Mger Course/Exm $75 EXECUTIVE Mger Mger Course/Exm $250 ADDING Proessiol Ceriicio: Triig Requiremes UNARMED Proessiol 14 hour UNARMED Bsic Clssroom/Exm (Ach PS-) $5 ALARM MONITOR Proessiol 12 hour ALARM MONITOR Bsic Clssroom/Exm (Ach PS-) $5 PS-23 Chge o Iormio orm ARMED Proessiol 14 hour UNARMED Bsic Clssroom/Exm (Ach PS-); d $5 (Icludes Urmed Proessiol) 24 hour FIREARM Bsic Course (Ach PS-) TOTAL DUE:
PS-1 Applicio or Ceriicio or Licesure Deprme o Public Sey Sdrds d Triig Prive Securiy Ceriicio & Licesig Progrm 4190 Aumsville Hwy SE, Slem, OR 97317-8983 Phoe: 503-378-8531 / Fx: 503-378-400 E-mil: securiy.ivesigors@se.or.us Websie: hp://www.orego.gov/dpss/ps For oice use oly PSID #: Amou: Received De 1 Plese idice he ceriicio d/or licesure you re pplyig or below: PROFESSIONAL CERTIFICATION Urmed Armed/Urmed Alrm Moior MANAGER LICENSURE Supervisory Execuive I you re lso pplyig or Proessiol Ceriicio Plese idice he ype o Proessiol Ceriicio bove INSTRUCTOR CERTIFICATION Urmed Firerms Alrm Moior ~ Mus currely hold ceriicio or opios lised below ~ UPGRADE Armed Upgrde llows he holder o mii he sme expirio de o he urmed ceriicio ADDING CERTIFICATION OR LICENSURE I you re ddig ceriicio d/or licesure Plese idice he ype o ceriicio/licesure bove 2 Geerl Iormio PLEASE TPE OR PRINT CLEARL Per OAR 259-00-0015 ~ All prive securiy providers mus oiy he Deprme wihi 14 cledr dys o y chge o ddress by compleig Prive Securiy Provider Chge o Iormio orm (PS-23). NAME Firs: Middle Iiil: Ls: Suix: *Socil Securiy Number: Previous Nme(s): Rce (Opiol): Aric Americ Asi/Pciic Islder Cucsi Hispic Nive Americ Geder: De o Birh: E-mil Address: Home Phoe: Work Phoe: Cell Phoe: Milig Address: Ciy: Se: Zip Code: Couy: (Exmple: Mulomh) Residece Address (I diere): Ciy: Se: Zip Code: Couy: (Exmple: Mulomh) * Applics re required o provide heir Socil Securiy Number (SSN) o DPSST. The uhoriy or his requireme is ORS 25.785 d ORS 305.385, 42 USC 405(c)(2)(C)(i), 42 USC ()(13). The SSN is used o obi crimil bckgroud iormio, or child suppor eorceme d x dmiisrio (icludig ideiicio) purposes oly. The SSN remis o ile DPSST. 3 5 Triig Reques Complee his secio ONL i pplyig or Isrucor Ceriicio or Mger Licesure DPSST Isrucor/Mger Triig De Reques 1 s Choice: 2 d Choice: For clss vilbiliy plese visi he Triig Cledr o he DPSST websie: www.orego.gov/dpsst/ps PS-1 Applicio or Ceriicio or Licesure Revised: 07/2015
4 Educio & Ceriicio Hisory PLEASE CHECK ALL THAT APPL & TPE OR PRINT CLEARL Per OAR 259-00-0020 ~ Applics or ceriicio or licesure mus hve ered oe o he ollowig: High School Diplom GED Pos-Secodry Degree* *issued by ccredied degree-grig college or uiversiy recogized by he Orego Oice o Degree Auhorizio [ORS 348.594(2)] Hve you ever pplied or or bee ceriied s prive securiy provider i Orego? 4 ES NO PSID#: 5 Employme PLEASE TPE OR PRINT CLEARL Are you currely employed s Prive Securiy Provider? ES NO Employig Busiess (Nme & Address): Busiess ID#: Employig Busiess (Nme & Address): Busiess ID#: Employig Busiess (Nme & Address): Busiess ID#: (I more employer s, plese lis o sepre shee o pper) 7 Morl Fiess Orego Revised Sues (ORS) d Orego Admiisrive Rules (OAR) require ll prive securiy pplics d providers uphold he core vlues esblished by he Bord o Public Sey Sdrds d Triig d be o good morl iess s deermied by crimil bckgroud check, deprme ivesigio or oher relible sources. Lck o good morl iess icludes, bu is o limied o, mdory or discreiory disquliyig miscoduc s described i OAR 259-00-0300. To view he crimil disquliier lisig plese visi he ollowig websie: www.orego.gov/dpss/ps/docs/psdisquls.2014.pd 1) Hs ceriicio or licese i y oher occupio or proessiol cpciy issued i your me i y se or by he ederl goverme ever bee reused, suspeded, revoked or resriced OR hve you ever volurily reliquished ceriicio/licese? ES NO I yes, ch explio d provide de, locio, d ure o oese. 2) Hve you ever bee coviced o, rresed OR is here y cio pedig gis you or y crimil oese? ES NO I yes, ch explio d provide de, locio, d ure o oese. 3) Hve you ever bee ivesiged, required o pper beore or bee scioed by y proessiol body or ederl or se gecy or lleged N Smiscoduc E icludig DPSST? OES NO I yes, ch explio d provide de, locio, d ure o oese. 7 9 8 E S E S N I E E Sigure O S NS o Applic O The iormio coied i his pplicio is rue d correc o he bes o my kowledge. I udersd h lsiicio I o yy N documes N submied o he deprme my be cuse or deil, suspesio or revocio o ceriicio or licesure e O I uder O ORS 181.878 d OAR 259-00-0300, d subjec o civil pely uder OAR 259-00-0450. I urher udersd s y h he iormio provided i his pplicio will be used o coduc bckgroud ivesigio., I I e y Sigure: s e De:, y sy CASHIERS/BUSINESS e, e CHECK OR CREDIT OR DEBIT CARD PAMENT MONE s sorder - Pyble o: DPSST Credi Crd Auhorizio Form: c,, ~ Csh/Persol checks will NOT be cceped ~ hp://www.orego.gov/dpss/ps/docs/credicrdauhorizio.pd h c MAIL TO: Pri, complee & mil wih ll oher pplicio merils Deprme h c o Sey Sdrds & Triig Prive Securiy h Ceriicio & Licesig 4190 e caumsville c Hwy SE Slem, x h Orego h 97317 p e l x e PS-1 Applicio or Ceriicio or Licesure Revised: 07/2015
PS-27 Prive Securiy Provider Code o Ehics I swer or irm h s Prive Securiy Provider, my udmel duy is o proec he ieres o my employer, clie d/or idusry. As prive securiy provider I recogize h I m boud o he core vlues speciic o my disciplie. I ckowledge h Hoesy is core vlue h icludes iegriy, credibiliy, cig hoorbly d miiig coideces. I ckowledge h lck o hoesy icludes uruhuless, dishoesy by dmissio or omissio, decepio, misrepreseio or lsiicio, d rom hese I will bsi. I ckowledge h Good Chrcer is core vlue h icludes beig respecul d coureous, beig ihul, dilige d loyl o he employer s chrge, d usig discreio, demosrig compssio, d exhibiig courge. I ckowledge h Fir Treme o Ohers is core vlue h icludes reig ohers equibly, exercisig good judgme d o beig discrimiory gis ohers. I ckowledge h Public Trus is core vlue which icludes miiig he public coidece by beig lw bidig d dherig o recogized prive securiy idusry sdrds. I ckowledge h Respec or he Lws o his Se d Nio is core vlue. I will cosly srive o mii hese core vlues, dedicig mysel o my chose proessio. Sigure Pried Nme De PSID Number or i ew eer N/A