Application Summary

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License Type: Security Guard

Application: Initial Security Guard Registration

Application Number: 7018403

Application Date: 03/28/2017 (mm/dd/yyyy)

Application Questions

Are you a Peace Officer or an Armored

Vehicle Guard?

Yes

Will you be submitting your fingerprints on

hard fingerprint cards?

Yes

Do you have employment pending the

issuance of your Security Guard

registration?

No

Have you served, or are you currently

serving, in the U.S. Armed Forces?

No

Are you requesting expediting of this

application for spouses or domestic partners

of an active duty member of the U.S. Armed

Forces?

No

Are you a Peace Officer or a level I or level II

reserve officer holding peace officer status

as defined by Chapter 4.5?

No

Are you currently employed as an armored

vehicle guard?

No

Personal Detail

First Name: Noel

Middle Name: Linsangan

Last Name: Acenas

Birthdate:

SSN/ITIN:

Addresses

License Related Addresses

Address of Record

Warning: In order to protect your privacy and identity, address will not be displayed.

License Attributes Selected

Transaction Hard Card

3/28/17 9:43 AM Page 2 of 2

Conviction Questions

Have you ever been convicted of, or plead

guilty or nolo contendere to any offense in

the United States or a foreign country?

No

Is any criminal action pending against you,

or are you currently awaiting judgment and

sentencing following entry of a plea or jury

verdict?

No

Attachments

Fees

Guard Initial Registration Fee $50.00

DOJ Fingerprint Fees (PSS) $32.00

FBI Fingerprint Fees (PSS) $17.00

Total Amount Due: $99.00

Applications are not considered submitted for processing until payment is received. Attestation

I declare under penalty of perjury, under the laws of the State of California, that all statements on this application are true and correct, with full knowledge that all statements herein are subject to investigation and that any false, dishonest, or incomplete answers to any questions on the application may be grounds for denial or subsequent revocation of my license and/or criminal prosecution.

Signature: Date:

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