Free Dos 1246 PDF Form Get Document

Free Dos 1246 PDF Form

The DOS 1246 form is a crucial document for security guards in New York State, serving as the application for the renewal of their registration. This form requires applicants to provide updated personal information, confirm compliance with training requirements, and address any legal obligations, such as child support. To ensure uninterrupted employment as a security guard, it's essential to fill out the DOS 1246 form accurately and submit it before the expiration date.

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Outline

The DOS 1246 form is an essential document for security guards in New York State seeking to renew their registration. It serves as a comprehensive application that not only facilitates the renewal process but also ensures compliance with various legal requirements. Applicants must provide updated personal information, including any changes to their name or address, and pay a nonrefundable fee of $25. The form also includes critical questions regarding any criminal convictions or pending charges, which must be answered truthfully. Additionally, it emphasizes the importance of completing mandatory training, such as the 16-hour On-The-Job training for those employed over 90 days and annual in-service training. A Child Support Statement is also required, highlighting the obligation to remain current on child support payments to avoid potential license suspension. Finally, the form mandates that applicants affirm the accuracy of their statements under penalty of perjury, reinforcing the seriousness of the information provided. Failure to follow these instructions can lead to delays in processing or even the need to reapply entirely.

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Key takeaways

  • Complete all sections: Ensure every question on the DOS 1246 form is answered. Missing information can delay processing.
  • Check your details: Review the preprinted information carefully. Any changes, especially your address, should be noted in the designated area.
  • Proof of name changes: If your name has changed, provide documentation such as a marriage certificate or court order.
  • Child support compliance: You must complete the Child Support Statement, regardless of whether you have children. Failure to do so can affect your license.
  • Training requirements: Confirm that all required training is completed and on file. This includes the 16-Hour On-The-Job training and the 8-Hour Annual In-Service training.
  • Submit original form: Mail the completed and signed original form along with the $25 nonrefundable fee. Payment can be made by check, money order, or credit card.
  • Renewal deadlines: Renew your registration before the expiration date to avoid the need to reapply and requalify.
  • Contact for questions: If you have any questions, reach out to the Division of Licensing Services. Always reference your Unique ID Number for assistance.

Form Preview Example

SECURITY GUARD RENEWAL

SEE INSTRUCTIONS ON BACK

 

 

 

 

 

PRINT ANY CHANGES IN INK IN THIS AREA

 

Unique ID Number

YOUR NEW LAST NAME

FIRST NAME

Ml

SUFFIX

$25.00

 

 

 

 

 

 

 

Fee Due

NEW HOME STREET ADDRESS (NUMBER STREET)

NEW HOME STREET CONTINUED

Current Term Expires:

1)Yes 0 No [i

2)i-7 No f

Yes LJ

3)Yes [1 No [i

NEW HOME CITY

STATE ZIP CODE+ 4 CNTY

Since your last application, have you been convicted of a crime or offense (not minor traffic violation), in this state or elsewhere? (If Yes, please enclose court disposition.)

Since your last application has any license, permit, commission, registration or application for a license, permit, commission or registration held by or submitted by you or a company in which you are or were a principal been revoked. suspended, or denied by any state, territory or governmentaljurisdiction or foreign country for any reason? (If Yes, enclose details).

Are there any criminal charges (misdemeanor or felony) pending against you in any court in this state or elsewhere? (If Yes, you must submit a copy of the accusatory instrument e.g. indictment, criminal information or complaint).

Notice:

Prier to renewal you must complete mandatory training (see instructions on reverse side ofform.) Our records show the following training is currently on flJe:

OJT:

Annual Training:

Annual Training:

OJTtraining is required of any guard employed for more than 90 days. If any of the above dates for annual training are missing, you must complete that training prior to submission ofyour renewal form.

Child Support Statement:

By signing this application. I certify that as of the d ate of this application. I am not under an obligation to pay child support OR if I am under an obligation to pay child support, I am not four or more months in arrears in the payment of child support, or I am making payments by income execution or by court agreed payment or repayment plan or by plan agreed to by the parties or my child support obligation is the subject of a pending court proceeding, or I am receiving public assistance or I am receiving public assistance or supplemental security income.

Applicant Affirmation:

I affirm. under the penalities of perjury. that the statements made in this application are true and correct.

In addition. I hereby autl1orize the t�YS Department of State and NYS Departmentof Motor Vehicles to produce an 1D card bearing my OMV photo. understand that DOS and DMV will use my DMV phto to produce all subsequent ID Cards for as long as I maintain my license with the Department of

State.

Applicant Signature

 

 

Date

 

 

 

 

 

 

Complete For Credit Card Payment

 

 

 

Applicant's Unique ID Number:

..-�

Total amount due: $ ________

□ Master Card

 

Applicant's Name:

 

 

 

Please charge to the following credit card:

□ Visa

I

 

I

 

Credit Card NO:

_I�1_1 �II� I___ I I

I

I I I I

I

I I I

Exp. Mo

Yr.

 

 

 

 

 

 

 

Print cardholder's name:

Cardholder's signature:

Date:

DOS -1246 Security Guard (Rev.5/14)

NYS DEPARTMENT OF STATE

DIVISION OF LICENSING SERVICES

PO BOX 5004, G.P.O.

NEW YORK, NY 10087-5004

Instructions:

1Answer all application questions and sign the Affirmation. Your renewal will not be processed without all of this information.

2Check the preprinted information (top left) and enter any changes in the space at right. It is important that you notify this Division of any changes to your residential address so you continue to receive renewal notices and any other notifications pertinent to your registration.

NOTE: If your name has changed (including changes due to marital status), please indicate the changes in the spaces to the right of the preprinted information. You must provide proof of such change of name, e.g., a copy of one of the following:

Court order changing your name Marriage certificate

Driver's license, or a non-driver's ID card Valid passport

Immigration documents

Child Support Statement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A Child Support

 

Statement

 

is

mandatory

in

New

York

State

(General

Obligations

Law).

The law requires you

to

complete

this

 

section

-

regardless

of

whether

or

 

not

you

have

children

or

any

support

obligation.

Any

person

who

Is four months

or

more

in

arrears

in

child

support may

be

subject

to

having his

or

 

her

 

business,

professional and driver's licenses suspended. The

 

intentional

submission

of

a false written statement for the purpose of frustrating or

defeating

the

lawful

enforcement

of

support

obligations

is

punishable

under

Section

175.35 of the

Penal Law. It

is

a

class E

felony

 

to

offer

a

false

instrument

 

for

filing

with

a

state or

local government

with the

intent to defraud.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Training Requirements

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

It you are not In compliance with these training requirements, you

 

 

 

may not submit this renewal form.

 

 

 

 

 

 

 

 

 

 

 

 

In order to renew your registration, the required training courses must

 

 

be completed and on file with our office. The reverse side of this

 

 

 

 

application displays your training currently on file wtth our office. The

 

 

 

following courses are required:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16-Hour On-The Job(OJT) - renewal form must display date if

 

 

 

 

 

employed for over 90 days.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8-Hour Annual In-Service - must be completed within each

 

 

 

 

 

year of your license term; renewal form must display two

 

 

 

 

 

 

completiondates

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If registered with our office to carry a firearm, you mustalso complete:

 

 

 

8-Hour Annual Firearms Course - must be completed each

 

 

 

 

 

calendar year; renewal form must display two completion dates

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Photo ID Card

 

 

 

 

Warning:

The

Department

of

State will not accept documents with

 

 

 

 

 

alterations

or

 

erasures. Presentation

of

 

fraudulent

documents

may

also

Your photo ID card

will be produced by the

NYS Department of

Motor

 

result

in criminal prosecution.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicles using the image on file in their office.

If you have a valid NYS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

Mail

this

completed,

signed.

original

renewal

notice

wrth

your

$25

Driver License or

Non-Driver ID with photo,

please read the

section

"InformedConsent" on the reverse side of this notice, sign and date tt.

 

nonrefundable

fee.

You may pay by check or money order made

 

 

 

 

 

 

 

payable

to

the

NYS

Department

of

 

State

or

charge any fee

to

Failure to adhere to these instructions will delay

 

 

MasterCard

or

Visa.

A

$20 fee

will

be

charged

for

any

check

 

 

issuance of your new registration.

 

 

-·----------------------

returned by your bank.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-----------------

 

 

 

--------------------

 

 

Please fold here to ensure the address below * * * DO NOT CUT - PLEASE RETURN

Security Guard Renewal Application

DO NOT DELAY: You cannot work as a security guard if you do not renew your registration by the expiration date of your current registration. Additionally if you do not renew your registration within 6 months after the expiration of your current registration, you will have to reapply and requalify.

appears in the window of the return envelope.

 

ENTIRE FORM FOR PROCESSING * * *

 

 

Questions?

Contact

the Division

of

Licensing

Services

at

(518)

474-7569. Please

reference

your Unique ID Number in all communications.

NYS DEPARTMENT OF STATE

DIVISION OF LICENSING SERVICES

PO BOX 5004, G.P.O. NEWYORK, NY 10087-5004