CITY OF FAIRBANKS PRIVATE DETECTIVE LICENSE APPLICATION

CITY OFFAIRBANKS(DATE STAMP)PRIVATE DETECTIVE LICENSE APPLICATION800 Cushman Street, Fairbanks, AK 99701(907) 459-6716TYPE OF PERMIT: NEW RENEWAL FEES DUE/COLLECTED: _______________________Name:MailingAddress:PhysicalAddress:Home Phone:Date of Birth:Years Experience as Private Detective:Previous License(s) Held (City & State):Other NameUsed:City, StateZip:City, StateZip:Work/Cell Phone:Place of Birth:Years of Alaska Residency:E-mail Address:Application Requirements$100.00 Non Refundable Application Fee for New Licenses.$400.00 Bi-Annual License Fee for New Applications and Renewals.Copy of Current Driver's License.Current Criminal History Report with 10 Year History.Current Driving Record with 5 Year History.Copy of State of Alaska Business License.Headshot Photograph in Electronic Format, if Not Applying in Person.$10,000.00 Bond**A $20,000 Bond for Out-of-State Applicants is required if Applicant is not registered in at least two other states.All required documents must be submitted with the signed and completed application.Business InformationName:Physical Address:Mailing Address:City, StateZip:City, StateZip:Phone Number:Alaska Business License No.Employment History (past 5 years)Employer:_________________________________________________________Position Held: ___________________Dates Employed:______________________ City/State: ___________________________________________________Employer:_________________________________________________________Position Held: __________________Dates Employed:______________________ City/State: ___________________________________________________

Revised February 28, 2012Criminal HistoryPLEASE ANSWER YES OR NO TO THE FOLLOWING QUESTIONS:YES or NOHave you ever been convicted of a felony?Have you ever been convicted of a crime involving moral turpitude?An Answer of YES to either of the above questions is grounds for denial of a Private Detective’s License by the City Clerk asper Fairbanks General Code 14.121-134. Please explain on a separate sheet of paper any convictions that meet the criteriaas noted above; including charges, places, dates, and sentences imposed. In the event of an adverse decision, theApplicant has the right to appeal the denial by the City Clerk after submission of a completed application and payment ofthe application fee. Request for an Appeal Form can be obtained at the City Clerk’s Office.Applicant’s StatementI, _________________________________________, being first duly sworn, depose and state that I am the individualmaking application for license and that the answers to the foregoing questions and other statements contained herein aretrue and complete to the best of my knowledge and belief. I understand that any materially false statement on thisapplication may be subject to revocation or denial of a permit.I certify that I am a natural born or a fully naturalized citizen of the United States. I certify that I do notbelieve in or advocate the overthrow of the Government of the United States, or of the State of Alaska,by force or violence. I certify that I am not a member of any organization or party that believes in orteaches, directly or indirectly, the overthrow of the Government of the United States, or of the State ofAlaska, by force or violence. I certify that I have read and understand FGC 14.121-134. I certify that Ihave read the application and understand the requirements for licensure.Sworn to before me this ______ day of ____________________, 20__._______________________________________________Signature_________________________________________________________Notary Public for the State of AlaskaMy Commission Expires: _____________________________________(SEAL)The Fairbanks General Code is attached to this application for your convenience; it is provided as a courtesy, but is thedistinct responsibility of the Applicant to understand the requirements and to be compliant. Signing of the above Oath,acknowledges having read the Code and certifies that he/she understands it. If the Applicant has any questions regardingthose reponsibilities, the questions should be asked prior to issuance of a license.Please make all necessary copies for your records before submission of your application to the Clerk’s Office. There will bea per page charge for any copying requested in accordance with FGC 2-775, with the exception of a request to copycriminal history reports, as State law prohibits copying of such documents.Thank you in advance for your cooperation.Administrative Use OnlyApproved By:Denied By:Date:Date:Reason for Denial:For additional information and/or forms, please visit the City of Fairbanks web site at: www.fairbanksalaska.usPrive Detective License Application - Page 2 of 2 M:\!indiv\city clerk files\Licensing\Applications\Private Detective - 2012