GOVERNMENT OF THE DISTRICT OF COLUMBIA
OCCUPATIONAL AND PROFESSIONAL LICENSING ADM INISTATION
BOARD OF SECURITY
TRANSFER REQUEST FORM
GENERAL INSTRUCTIONS
All applicants must complete every section of this form and submit both original wallet and 5X7 licenses with the total fee due. False or misleading statements will be
cause for disciplinary action and could be cause for criminal prosecution pursuant to DC Code 22-2514. If you have any questions, call Pearson VUE Customer Service at
1-888-204-6293.
1.
TYPE OF APPLICATION FEES
This form will be returned unprocessed if the fee is not included or if the fee is insufficient. Make company check, cashier’s check or money order payable to:
Pearson VUE. CASH OR PERSONAL CHECKS WILL NOT BE ACCEPTED. You must also submit both original wallet and 5X7 licenses with
this request.
q
q
q
q
q
MAKE FEE PAYABLE TO:
Security Officer Agency Transfer
$30.00
Special Police Officer Agency Transfer
$30.00
Campus/University Security Dept. Transfer
$30.00
Private Detective Agency Transfer
$30.00
Cancel Affiliation
NO FEE
PEARSON VUE
A charge of $65.00 will be imposed for dishonored checks.
(Public Law 89-208)
2A. NAME OF LICENSEE
FIRST NAME
LAST NAME
M. I.
SUFFIX
(e.g. “Jr.”, “Sr.”, not “M.D.”)
TRADE NAME Optional – Private Detectives
.
2B. SOCIAL SECURITY NUMBER
-
2C.
LICENSE NUMBER
PREFIX
3.
PREVIOUS SECURITY AGENCY RELEASE/CANCEL AFFILIATION
This section MUST be completed by the agency who is releasing the employment of the Security Officer, Special Police Officer, or Private Detective. You
must submit your original wallet and 5x7 licenses with this request. To continue to practice in the District of Columbia an APPLICANT MUST also have
their New Security Agency complete Section 4. If Section 4 is not completed your license status will be inactive.
COMPANY NAME
AGENCY LICENSE NUMBER
AGENCY FEIN
______________________________________________________________________________
___________________________
AGENCY PRINCIPLE SIGNATURE
4.
DATE
NEW SECURITY AGENCY
To continue to practice in the District of Columbia an APPLICANT MUST have this section completed by their New Security Agency to complete the
Security Agency Transfer. If this section is not completed your license status will be inactive.
AGENCY NAME
AGENCY LICENSE NUMBER
AGENCY FEIN
I recommend that the request for transfer by
___________________________________________________________________________________ be honored
_____________________________________________________________________________
___________________________
AGENCY PRINCIPLE SIGNATURE
Security Officer (SO) * Private
Detective (PD)
MAIL ALL REQUIRED ITEMS TO:
Pearson VUE/DC Board of Security
8401 Corporate Drive, Suite 250
Landover, MD 20785
1-888-204-6293
DATE
Special Police Officer (SPO) * Campus Police Officer (SCP)
TAKE ALL REQUIRED ITEMS TO:
Security Officer Management Branch (SOMB)
2000 14th Street NW, Room 302
Washington, DC 20009
202-671-0500
OFFICE ONLY
License/Letter
Date: ________________
Payment Amount: ________________
Clerk’s Initials: __________________
Pearson VUE #6509-06 Revised 5/25/16