Form FDACS-16022 "Application for Class '"a'", '"b'", or '"r'" Agency License" - Florida

What Is Form FDACS-16022?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2014;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form FDACS-16022 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-16022 "Application for Class '"a'", '"b'", or '"r'" Agency License" - Florida

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Application For
CLASS “A”
PRIVATE INVESTIGATIVE
AGENCY LICENSE
CLASS “B”
SECURITY AGENCY LICENSE
CLASS “R”
RECOVERY AGENCY LICENSE
02/2014
Application For
CLASS “A”
PRIVATE INVESTIGATIVE
AGENCY LICENSE
CLASS “B”
SECURITY AGENCY LICENSE
CLASS “R”
RECOVERY AGENCY LICENSE
02/2014
NOTICE TO APPLICANTS FOR LICENSES
ISSUED PURSUANT TO CHAPTER 493, FLORIDA STATUTES
MANDATORY DISCLOSURE OF SOCIAL SECURITY NUMBERS
Sections 493.6105, 493.6304, and 493.6406, Florida Statutes (F.S.), in conjunction with Section 119.071(5)(a)2, F.S.,
mandates that the Department of Agriculture and Consumer Services, Division of Licensing, obtain Social Security
numbers from applicants. Applicant Social Security numbers are maintained and used by the Division of Licensing
for identification purposes, to prevent misidentification, and to facilitate the approval process by the Division. The
Department of Agriculture and Consumer Services, Division of Licensing, will not disclose an applicant’s Social Security
number without consent of the applicant to anyone outside of the Department of Agriculture and Consumer Services,
Division of Licensing, or as required by law. [See Chapter 119, F.S., 15 U.S.C. ss. 1681 et seq., 15 U.S.C. ss. 6801 et
seq., 18 U.S.C. ss. 2721 et seq., Pub. L. No. 107-56 (USA Patriot Act of 2001), and Presidential Executive Order 13224.]
TO PREVENT UNNECESSARY DELAYS IN THE PROCESSING OF YOUR APPLICATION, ANSWER ALL
QUESTIONS AND SUBMIT ANY DOCUMENTATION NECESSARY TO SUPPORT YOUR ELIGIBILITY.
AGENCY APPLICATION u
PART ONE
SECTION I
AGENCY INFORMATION
1. FILL IN ONLY ONE circle to indicate whether you are applying for a Class “A” Private Investigative Agency license,
a Class “B” Security Agency license, or a Class “R” Recovery Agency license. If you are applying for more than
one class of agency license, a separate application is required for each.
2. If you intend to do business under a fictitious name or are applying as a corporation or limited liability company
(LLC) , call the Division of Licensing for tentative name approval prior to filing with the Florida Department of State,
Division of Corporations, for your fictitious name and/or registration as a corporation or LLC. To help ensure the
proposed agency name is not taken by another applicant, submit your application for an agency license to the
Division of Licensing as soon as possible after tentative approval is obtained. Please note that tentative name
approval DOES NOT constitute a reservation of that name. A proposed name is not added to Division records
until the application is received.
3. To conduct business in Florida, you must provide a FLORIDA BUSINESS address, which will be considered your
primary business location in this state. A P.O. Box or Mail Drop is not considered a business address. If you have
a mailing address in addition to the business address, be sure to provide this information, as well.
4. Each agency and branch office is required to have at least one licensed manager for each location.

A Class “C” licensee may be designated as the manager of a Class “A” agency, in which case the Class “M” or
“MA” license is not required.

A Class “D” licensee who has been so licensed for a minimum of two years may be designated as manager of
a Class “B” agency or “BB” branch office, in which case the Class “MB” or “M” license is not required.

A Class “E” licensee may be designated as the manager of a Class “R” agency, in which case the Class “MR”
license is not required.
5a. Specify whether the agency is a 1) sole proprietorship; 2) partnership; or 3) corporation/LLC.
5b. List the names and titles of the sole proprietor/partners/corporate officers/LLC managers.
6a. If you answer “yes” to this question, list all states, including Florida, where the business/agency is licensed, or
was previously licensed, to perform similar activities. Provide inclusive dates and names under which the agency/
business has operated.
6b. If you answer “yes” to this question provide on a separate sheet of paper complete details regarding the disciplinary
.
action, including the state in which the action occurred, relevant dates, and circumstances
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AGENCY APPLICATION u
PART TWO
Who completes Part Two?
Sole Proprietorship – Owner completes Part Two.
Partnership – Each partner must complete Part Two.
Corporation/LLC – If the structure is a corporation, the president, vice president, secretary, and treasurer must
each complete part two. If the structure is a limited liability company ( LLC ), each manager must complete part two.
If a manager of the LLC is a corporation, the president, vice president, secretary, and treasurer of that corporation
must each complete part two. Four copies of Part Two are provided. Additional copies of the application may be
downloaded from our website: www.mylicensesite.com.
SECTION I
APPLICANT INFORMATION

Must be at least 18 years of age.

Must be a citizen or legal resident alien of the United States or have been granted authority by the Department of
Homeland Security, U.S. Citizenship and Immigration Services (USCIS) to own and operate the type of agency for
which you are applying.

Must provide current RESIDENCE address. A P.O. Box is not considered a residence.
SECTION II
MILITARY HISTORY
Complete this section to indicate whether you have ever been court-martialed, fined, or disciplined under the Uniform
Code of Military Justice (UCMJ) or service regulations. If you respond YES to the question in this section, provide a
complete and accurate account of this matter on a separate sheet of paper and provide copies of all official military
documents related to the incident(s).
SECTION III
CRIMINAL HISTORY
The Department will deny your application if you:

have been convicted of a felony in any state or of a crime against the United States, which is designated as a
felony, or convicted of an offense in any other state, territory, or country punishable by imprisonment for a term
exceeding 1 year, unless and until Civil Rights have been restored and a period of 10 years has passed since
final release from supervision [s.493.6118(4), F. S.]. Proof of restoration of Civil Rights must be submitted with this
application. Questions regarding the procedure for applying for restoration of Civil Rights or restoration of Firearm
Rights should be addressed to The Office of Executive Clemency; Florida Commission on Offender Review; 4070
Esplanade Way; Tallahassee, FL 32399-2450, Toll Free 1-800-435-8286; Phone (850) 488-2952.

are currently serving a suspended sentence on a felony charge or on probation for a felony charge [s.493.6118(4),
F. S.].
The Department may deny your application if you:

have a history of being arrested for crimes of violence and/or found guilty of (or had adjudication withheld for)
directly related crimes. This includes, but is not limited to: Trespassing, Breaking and Entering, Burglary, Robbery,
Forgery, Criminal Mischief or Theft, Assault, Battery, Stalking, Aggravated Battery, Aggravated Assault, Sexual
Battery, Kidnapping, Armed Robbery, Murder, Aggravated Stalking, Resisting an Officer with Violence [Section
493.6118(1)(c), Section 493.6118(1)(j), Section 493.6118(3), F.S.].

have demonstrated a lack of respect for the laws of this state and the nation [Section 493.6118(3), F.S.].

have an outstanding bench warrant or capias [Section 493.6118(3), F.S.].

are currently in a Pre-Trial Intervention or Deferred Prosecution Program [Section 493.6118(3), F.S.].
You must provide complete information about your arrest(s) and include certified copies of court dispositions.
A determination of your eligibility cannot be made until all documentation is received and a complete criminal
history record check has been completed. This process takes 1-3 months.
SECTION IV ALIAS INFORMATION
If you are known by any other name, be sure to include it in this section. This includes nicknames, married names,
maiden names, a legal name change, alias names, fictitious names, etc.
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SECTION V
PERSONAL HISTORY
a. If you have ever been adjudicated incapacitated (determined by the court to be incapable of taking care of yourself),
you must provide a copy of the court document restoring your capacity.
b. If you have ever been involuntarily placed in a treatment facility for the mentally ill under Chapter 394, F.S., or
similar laws of another state, you must provide a copy of the court document restoring your competency.
c. If you have ever been diagnosed with a mental illness, you must provide a statement from a psychologist or
psychiatrist licensed in Florida attesting that you are not currently suffering from a mental illness that precludes you
from performing duties regulated under Chapter 493, F.S.
d. If you are currently abusing a controlled substance, you are not eligible for licensure.
e. If you have a history of controlled substance abuse, you must provide evidence of successful completion of a
substance abuse rehabilitation program and three letters of reference, one of which should be from your sponsor
in the program.
f.
If you have a history of alcohol abuse, you must provide evidence of successful completion of an alcohol rehabilitation
program and three letters of reference, one of which should be from your sponsor in the program.
SECTION VI TRAINING/EXPERIENCE
a. If you answer “yes” to this question, list all states, including Florida, where you are licensed, or were previously
licensed, to perform similar activities. Provide inclusive dates and names under which the agency/business has
operated.
b. If you answer “yes” to this question provide on a separate sheet of paper complete details regarding the disciplinary
.
action, including the state in which the action occurred, relevant dates, and circumstances
SECTION VII CERTIFICATION OF QUALIFIED EXEMPTION FROM PUBLIC RECORDS DISCLOSURE
Section 119.071, F.S.,
excludes from public disclosure specified information such as home addresses, telephone
numbers, Social Security numbers, and photographs pertaining to certain individuals. To determine whether you
qualify for an exemption, read the complete text of the law on line at http://www.leg.state.fl.us/Statutes/. IF YOU
QUALIFY FOR EXEMPTION, answer this question to specify whether you want the statutorily exempt information to
be kept from public disclosure. If you do NOT qualify for the exemption, leave it blank.
SECTION VIII CITIZENSHIP
If you are not a U.S. Citizen, you must submit proof of current employment authorization issued by the Department of
Homeland Security, U.S. Citizenship and Immigration Services (USCIS). A COPY of the front and back of one of the
following USCIS forms is sufficient: I-551, I-766.
SECTION IX
PERSONAL INQUIRY WAIVER AND NOTARIZATION STATEMENT
Do not sign the application until you are in the presence of the Notary Public who will notarize your application.
GENERAL INFORMATION

You may not provide services regulated under Chapter 493, or advertise as providing such services, until your
license is issued.

An applicant or licensee is ineligible to re-apply for the same class of license for a minimum period of one year
following final agency action of denial or revocation of a license. However, this time restriction shall not apply to
administrative denials where the basis was either of the following:
1. An inadvertent error or omission on the application or failure to submit required fees; or,
2. The Department was unable to complete the criminal background investigation due to insufficient information
from the Department of Law Enforcement, the Federal Bureau of Investigation, or any other applicable law
enforcement agency.

Class “B” applicants are required to submit proof of commercial general liability insurance coverage (form
FDACS-16004) prior to issuance of the license. The insurance coverage must be maintained during the life of the
license and must provide for a combined single limit policy in the amount of $300,000. Coverage must insure for the
liability of all employees licensed by the department while acting in the course of their employment.
NOTE: Proof of insurance is NOT required when the application is submitted, but upon approval of the application
by the Division of Licensing. You will be notified in writing when the application is approved. The approval letter will
inform you of any items required for your license to be issued.
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Submit your application to the Department of Agriculture and Consumer Services, Division of Licensing, Regional
Office nearest you - or mail it to the Department of Agriculture and Consumer Services, Division of Licensing, Post
Office Box 5767, Tallahassee, Florida 32314-5767.
INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION
COLOR PHOTOGRAPH (Refer to Photograph Specifications on following page.)
FINGERPRINT SUBMISSION (Refer to Fingerprint Submission Instructions on following page.)
FEES (paid by check or money order made payable to the Florida Department of Agriculture and Consumer
Services.) Fees are nonrefundable and nontransferable.
Application Fee:
$50
Sole Proprietor, Partner (each), Corporate Officer (each), LLC Manager (each)
Fingerprint Processing Fee:
$42
Sole Proprietor, Partner (each), Corporate Officer (each), LLC Manager (each)
TOTAL FEES REQUIRED
$92
The $450 license fee is NOT required when you submit the application, but rather, upon approval of the application
by the Division of Licensing.
If you are also submitting an application for another class of license under Chapter 493, F.S., at this time, submit
only one set of fingerprints and a single fingerprint-processing fee. If you have submitted a set of fingerprints and
a fingerprint-processing fee for a license under Chapter 493 within the past six months, no fingerprint submission
or fingerprint-processing fee is necessary at this time.
If you are a permanent legal resident alien, you must submit a copy of your “green card” issued by the USCIS.
If you are neither a U.S. citizen nor a permanent legal resident alien, you must submit documentation issued by
the United States Citizenship and Immigration Services stating that you are lawfully in the United States and
authorized to own and operate the type of agency for which you are applying. An employment authorization card
issued by the United States Citizenship and Immigration Services is not sufficient documentation.
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