Please complete the following:
Have you ever been convicted of a felony, misdemeanor, or ordinance violation involving moral turpitude in any
City or State within the past ten (10) years, excluding traffic violations? If yes, explain:
Have you been convicted of fraud, deceit, or misrepresentation within the ten (10) years preceding the date of this
application? If yes, explain:
Have you ever had an application for security service employee or agent denied?
If yes, explain:
If this is a new application, attach evidence of satisfactory completion of an approved twenty-four (24) hour private
security training course, or an acceptable equivalent.
If this is a renewal application, attach documentation of completion of at least twenty-four (24) hours of in-service
training which you received during the past year.
Applicant’s Signature Date
Misrepresentation or false information on this application is grounds for denial of the permit and
possible criminal prosecution.
Armed Guard Applicants Only
The applicant’s employer must request, in writing, that the applicant be licensed to carry a firearm as part of employment. Complete the
Firearm furnished by:
Make Model Caliber Serial # If you furnish your
own firearm, how long have you owned it?
Attach evidence of satisfactory completion of an approved sixteen (16) hour training course or acceptable equivalent (renewal application
requires four (4) hours of refresher firearms training).
Chief of Police Date
Fingerprinted By: Date:
Chief of Police
Director of Finance
A license issued under the provisions of Chapter 5.32 Evans Municipal Code, is issued provisionally and its issuance is based
upon reliance of the statements of the applicant that he or she is a person eligible to be so licensed. Any license so issued shall become null
and void upon written notification to the applicant that he or she is a person prohibited from being so licensed or has been found to have
made false or misleading statements in this application.