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Blank Texas Psb 20 PDF Template

The Texas PSB 20 form is a critical document used for applying for a governmental letter of authority exemption in the private security sector. This form gathers essential information about the applicant, including personal details, background checks, and employment verification. Understanding the requirements and proper completion of this form is vital for ensuring compliance with Texas regulations.

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Open Form

Contents

Form Example

Texas Department of Public Safety Regulatory Services Division

www.txdps.state.tx.us

• MUST USE MOST CURREN T			PRIVATE SECURITY
FORM			PRIVATE SECURITY
• KEY I N OR PRI N T CLEARLY I N BLACK I NK	EXAMPLE:
	EXAMPLE:
• MAKE SURE ENTI RE CI RCLE I S FI LLED	Yes		No 
	Yes		No 

GOVERNMENTAL LETTER OF AUTHORITY (GLOA) EXEMPTION APPLICATION

REGI STRATI ON I NFORMATI ON

		 THE ABOVE SPACE I S RESERVED FOF OFFI CE USE ONLY 

Type of Registration: (CHOOSE ONE)	Type of Application: (CHOOSE ONE)
 Governmental Letter of Authority Non-Commissioned Security Officer	 Original Application
 Governmental Letter of Authority Commissioned Security Officer	 Renewal Application
 Governmental Letter of Authority Personal Protection Officer

APPLI CANT I NFORMATI ON

Gov Letter of						Gov Letter of Authority
Authority Name						License No.

Applicant Social	-	-		Driver License	DL/ I D		DL/ I D
Security Number				I D Card	State:		No.
Security Number				I D Card			No.

Applicant Last Name

Home Address

First Name

Middle Name

Suffix

(I f Any)

City	State	ZI P	Home	(	)
	State		Home
	(2- Digit Code)		Phone

Date of Birth

Place

(CI TY)

(STATE)

(COUNTRY)

(MM/ DD/ YYYY)

of Birth

Gender

Male

 Female 

Eyes

 1.

Blue

 2.

Brown

 3.

Gray

 4.

Hazel

 5.

Green

 6.

Black

Height

Ft.

I n.

Hair

 1.

Black

 2.

Red

 3.

Gray

 4.

Brown

 5.

Blonde

 6.

Bald

Race

 1.

 2.

 3.

 4.

 5.

 6.

Weight

Lbs.

White

Black

Hispanic

American

Asian

Other

I ndian

_______

List any alias you have used:

Describe

Your Duties:

SUPPLEMENTAL I NFORMATI ON (REQUI RED WI TH ORI GI NAL APPLI CATI ON ONLY – DOES NOT APPLY TO RENEWALS)

Regarding submitting Fingerprints: (CHOOSE ONLY ONE)

I am submitting two (2) classifiable, Board approved fingerprint cards along with the $ 25 FBI classification fee.

I am submitting the $ 25 FBI classification fee. My fingerprints were submitted electronically and my signed I BT FAST receipt is attached as proof with this application.

I am a Peace Officer (or Retired Peace Officer) alternatively submitting a PSB-00 (Peace Officer Fingerprint Waiver) form with this application, instead of FBI fingerprint cards.

PAYMENT I NFORMATI ON

Original Registration Application Fee OR Renew al Fee: $0

I am submitting the appropriate fee(s) with this application by mail.	Yes
(Note: Payment must be in the form of a cashier’s check, money order or company check.)	No



* I f yes, a PSB-50 form m ust be submitted with this application.

I understand all fees submitted to Private Security are non- refundable and non transferable. I n accordance with Administrative Rule Yes



35.77, I have 90 days from the date the application is received by the Department to submit all required documentation, supplemental information and/ or fees or this application will be abandoned and I will be required to reapply.



PSB-20 (Rev. 06/ 2011)

Page 1 of 2

FORM

Applicant Name

Social	-	-
Security No.

BACKGROUND I NFORMATI ON – PART I ( ALL APPLI CANTS)

Have you ever been convicted, in any jurisdiction, of a felony

Yes

 * I f yes, has it been LESS than ten (10) years since

completing

your

Yes



level offense?

 sent ence or probat ionary period?



Have you ever been convicted, in any jurisdiction, of a Class A or

Yes

 * I f yes, has it been LESS than five (5) years since completing your sent ence

Yes



equivalent misdemeanor?

 or probat ionary period?



Have you, within the past 5 years, been convicted, in any jurisdiction, of a Class B misdemeanor or equivalent offense?

Yes



Are you currently charged with, or under indictment for, a felony, or Class A misdemeanor?

Yes



Are you currently charged with a Class B misdemeanor?

Yes



Have you ever been found by a court to be incompetent by reason of mental defect?

Yes



Yes

 * I f yes, and

you

received a dishonorable discharge, a bad conduct discharge, or

other

than

Were you discharged from the military?

 honorable discharge, from Armed Forces, then you must submit a copy of your DD- 214 .

Are you required to register as a sex offender, in the state of Texas or any other state?

Yes



Federal law prohibits the Bureau from issuing a license to anyone

Yes

 I f yes, you must submit documentation of your naturalization or a copy

who is ineligible to work in the U.S. Are you a non- citizen?

 of your permanent resident card.

BACKGROUND I NFORMATI ON – PART I I ( COMMI SSI ONED SECURI TY OFFI CERS & PERSONAL PROTECTI ON OFFI CERS ONLY)

10.

Are you currently restricted under a court protective order or subject to a restraining or affecting the spousal relationship, other than a

Yes



restraining order solely affecting property interests, including any court order restraining your conduct as to an intimate partner?



11.

Have you been diagnosed by a license physician as suffering from a psychiatric disorder or condition that causes or is likely to cause substantial

Yes



impairment in judgment, mood, perception, impulse control, or intellectual ability? (See Occupations Code §1702.163 (d), (e) & (f).)



12.

Have you been convicted in any court of a misdemeanor offense involving domestic violence?

Yes



13.

Are you an unlawful user of a controlled substance or addicted to any controlled substances?

Yes



BACKGROUND I NFORMATI ON – PART I I I ( ALL APPLI CANTS)

14.

I understand that, any pending charges or conviction referred to in Background I nformation Parts I and I I above require the submission of the

Yes



appropriate court documentation, with this application. Failure to report an arrest or conviction, later found by a fingerprint search, may result



in denial or revocation of a license based solely on the material misstatement of fact in this application.

15.

I acknowledge that I have review ed the eligibility criteria of Occupations Code §1702.113 and the definition of ‘conviction’ provided in §1702.371

Yes



and Administrative Rule §35.1. I also acknowledge that I have review ed the disqualifying offenses listed in Administrative Rules 35.42 and 35.46.



EMPLOYER I NFORMATI ON (TO BE COMPLETED BY QUALI FI ED MANAGER, MANAGER’S DESI GNEE OR OWNER)

I hereby certify that the above applicant began employment in a position that requires this registration with my company on:

Applicant’s Date of Employment (MM/ DD/ YYYY)

I am requesting that the above applicant be issued a registration with my company as my employee.

Manager or Manager’s Designee Printed Last Name

Printed First Name

I verify that the information provided is true and correct, and I understand that this is an official Government record and that any false statement made on this document or any other supplement provided to the Department may result in criminal prosecution.

Applicant Signature________________________________________________	Date____ / ____ / ________
Manager or Manager’s Designee Signature________________________________________________	Date____ / ____ / ________
This form and attachments can be forwarded by mail to:

Texas Department of Public Safety

Private Security MSC 02 42

PO Box 15999

Austin, TX 7 8761 - 5999

PSB-20 (Rev. 06/ 2011)

Page 2 of 2

FORM

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Common mistakes

Using an outdated form: Applicants often forget to use the most current version of the Texas PSB 20 form. It is essential to download the latest form from the Texas Department of Public Safety's website.
Illegible handwriting: Filling out the form in a manner that is difficult to read can lead to delays. Always print clearly in black ink to ensure all information is legible.
Incomplete sections: Some applicants neglect to fill out all required fields. Missing information can result in the application being returned or delayed.
Improper payment method: Submitting payment in a form other than a cashier’s check, money order, or company check can lead to rejection. Ensure you follow the payment guidelines specified in the form.
Neglecting to submit fingerprints: Failing to include the required fingerprint cards or documentation can halt the application process. Make sure to choose the correct option regarding fingerprints.
Ignoring deadlines: Applicants often overlook the 90-day deadline to submit all required documentation and fees. If this deadline is missed, the application will be considered abandoned.

Key takeaways

Always use the most current version of the Texas PSB 20 form. This ensures compliance with the latest regulations and requirements.
Fill out the form clearly, using black ink for legibility. Make sure to complete every section, including any required circles.
Be aware of the payment requirements. Fees must be submitted via cashier’s check, money order, or company check, and are non-refundable.
Submit all necessary documentation within 90 days of application receipt. Failure to do so may result in your application being abandoned.

⇓ Texas Psb 20 PDF

Steps to Using Texas Psb 20

Completing the Texas PSB 20 form requires careful attention to detail. Each section must be filled out accurately to ensure your application is processed without delays. Follow these steps to fill out the form correctly.

Obtain the most current version of the Texas PSB 20 form from the Texas Department of Public Safety website.
Begin by filling in your type of registration. Choose from the options provided: Non-Commissioned Security Officer, Commissioned Security Officer, or Personal Protection Officer.
Select the type of application you are submitting: Original Application or Renewal Application.
Provide your personal information, including your name, social security number, and driver's license or ID number. Ensure all entries are clear and legible, using black ink.
Fill in your home address, date of birth, place of birth, and contact information. Indicate your gender, eye color, hair color, height, weight, and race accurately.
If you have used any aliases, list them in the designated space. Additionally, describe your duties related to the position you are applying for.
For original applications only, select how you will submit your fingerprints and provide the necessary documentation or fees as indicated.
Indicate whether you are submitting the application fee by mail. If yes, ensure you include a cashier’s check, money order, or company check.
Answer the background information questions truthfully. This includes questions about any past convictions, military discharge status, and whether you are required to register as a sex offender.
If you are a commissioned security officer or personal protection officer, complete the additional background questions specific to those roles.
Have the qualified manager or owner complete their section, certifying your employment and signing the form.
Finally, sign and date the application before mailing it to the Texas Department of Public Safety at the address provided on the form.