Contents
Form Example
Texas Department of Public Safety
Private Security Bureau
PO Box 4087, Austin, Texas
www.txdps.state.tx.us
DECLARATION OF PSYCHOLOGICAL AND EMOTIONAL HEALTH
Name: _______________________________________________________________________________
Last |
First |
MI |
Social Security Number: _______________________________ |
Date of Birth: ___________________ |
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Psychologist’s Declaration for ORIGINAL APPLICATION as a Personal Protection Officer Authorization
I certify that I have completed a psychological evaluation of the above named individual, including the Minnesota Multiphasic Personality Inventory and find this individual to be in satisfactory emotional health to perform the duties of a personal protection officer as required by the provisions of Chapter 1702 Occupations Code.
Name of Psychologist: __________________________________________________________________________
Address: _____________________________________________________________________________________
CityStateZip
Telephone (area code + number): _________________________________________________________________
Texas State Board of Examiner of Psychologists License Number: _______________________________________
Signature of Examining Psychologist: ______________________________________________________________
Date: ________________________
This declaration is NOT public information and is valid for one year unless withdrawn or invalidated, and is valid only if signed by a licensed psychologist, pursuant to Title 10, Chapter 1702 Occupations Code, as amended.
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Rev. 03/05 |
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Common mistakes
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Incomplete Information: Failing to fill out all required fields can lead to delays. Ensure that every section, including name, Social Security number, and date of birth, is fully completed.
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Incorrect Psychologist Details: Providing inaccurate information about the psychologist, such as their name or license number, can invalidate the form. Double-check these details before submission.
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Missing Signature: The signature of the examining psychologist is crucial. Without it, the declaration is not considered valid.
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Outdated Evaluation: Submitting a psychological evaluation that is older than one year is a common mistake. Ensure that the evaluation is current and meets the specified requirements.
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Ignoring Formatting Requirements: Not adhering to the required format for addresses or phone numbers can lead to confusion. Follow the specified format closely.
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Overlooking Submission Instructions: Failing to follow the specific submission guidelines, such as mailing to the correct address, can result in processing delays.
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Neglecting to Keep Copies: Not retaining a copy of the submitted form for personal records can be problematic. Always keep a copy for your own reference.
Key takeaways
When filling out and using the Texas PSB 13 form, keep these key takeaways in mind:
- Understand the Purpose: The PSB 13 form is essential for those applying to become personal protection officers in Texas. It assesses psychological and emotional health.
- Complete the Form Accurately: Ensure all personal information, such as your name, Social Security number, and date of birth, is filled out correctly. Any errors can delay your application.
- Psychologist’s Evaluation: A licensed psychologist must conduct your evaluation. This includes administering the Minnesota Multiphasic Personality Inventory (MMPI).
- Validity Period: The declaration is valid for one year. After that, you may need to renew it to maintain your eligibility.
- Confidentiality: The information on the PSB 13 form is not public. It is protected and will only be used for the intended purpose of your application.
- Signature Requirement: The form must be signed by the examining psychologist. Without this signature, your application will not be considered.
Take these points seriously to ensure a smooth application process. Missing any detail could lead to unnecessary delays or complications. Act promptly and make sure everything is in order.
Steps to Using Texas Psb 13
Filling out the Texas PSB 13 form requires careful attention to detail. This form is essential for individuals seeking to demonstrate their psychological and emotional fitness for duties as personal protection officers. Follow these steps to complete the form accurately.
- Obtain a copy of the Texas PSB 13 form from the Texas Department of Public Safety website or your local office.
- In the first section, enter your full name: last name, first name, and middle initial.
- Provide your Social Security number in the designated field.
- Fill in your date of birth.
- Ensure that a licensed psychologist completes the next section. They must provide their name and address.
- The psychologist should include their city, state, and zip code.
- Enter the psychologist's telephone number, including the area code.
- Record the Texas State Board of Examiner of Psychologists license number.
- The psychologist must sign the form, confirming the evaluation has been completed.
- Finally, the psychologist should date the form before submission.