Transcription of APPLICATION FOR PROFESSIONAL INVESTIGATOR …
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APPLICATION FOR PROFESSIONAL INVESTIGATOR …
FOR OFFICE USE ONLYFEE PAYMENT INFORMATION (Check One Box)CSCL/LPI-010 (10/19) Page 1 of 2 Corporations, Securities & Commercial Licensing Licensing Box 30018, Lansing, MI OF MICHIGANFEES ARE AUTHORIZED BY 1965 PA 285 FOR OFFICE USE ONLYLARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals (First, Middle, Last)AddressCityStateZip CodeTelephone NumberE-mail AddressMake your check or money order in Currency payable to: APPLICATION FOR PROFESSIONAL INVESTIGATOR , BRANCH LICENSE & RELICENSUREAUTHORITY: 1965 PA 285, MCL , AND 42 USC 654 PENALTY: FAILURE TO PROVIDE THIS INFORMATION MAY RESULT IN DENIAL OF THE APPLICATION AND/OR DISCIPLINARY you ever been convicted of a felony not previously reported to the Department for this license type or occupation?NoYesNew License$ $ (dishonesty or fraud; unauthorized divulging or selling of information or evidence; impersonation of a law enforcement officer or employee ofthe United States or a state, or a political subdivision of the United States or state; illegally using, carrying, or possessing a dangerousweapon; 2 or more alcohol related offenses; controlled substances under the public health code, 1978 PA 368, MCL to ;or an assault)Have you been convicted of a misdemeanor involving any of the following?
FEE PAYMENT INFORMATION (Check One Box) FOR OFFICE USE ONLY CSCL/LPI-010 (07/15) Page 1 Michigan Department of Licensing and Regulatory Affairs
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