Fill in a Valid Dos 1246 Form Get Your Dos 1246 Now

Fill in a Valid Dos 1246 Form

The DOS 1246 form is a renewal application for security guards in New York State, designed to ensure compliance with licensing requirements. This form collects essential information, including personal details, training records, and any legal issues that may affect the applicant's eligibility. Completing the form accurately is crucial, as it directly impacts the ability to continue working in the security field.

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Example - Dos 1246 Form

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permit, commission or registration held by or submitted by you or a company in which you are or were a principal been revoked.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

Documents used along the form

The DOS 1246 form is essential for renewing your security guard registration in New York State. Along with this form, several other documents may be required or beneficial for a smooth renewal process. Below is a list of commonly used forms and documents that accompany the DOS 1246 form.

  • Child Support Statement: This document is mandatory in New York State. It confirms whether you have any child support obligations and if you are in compliance with those obligations. Failure to provide accurate information may lead to license suspension.
  • Proof of Name Change: If your name has changed since your last application, you must provide documentation such as a marriage certificate, court order, or other legal documents verifying the name change.
  • Training Certificates: Certificates proving completion of required training courses must be submitted. This includes the 16-hour On-The-Job training and 8-hour Annual In-Service training, as well as any firearms training if applicable.
  • Criminal Record Documentation: If you have been convicted of a crime or have pending charges, you need to provide court documents or other official records that detail the situation.
  • Employment Verification: A letter or document from your employer confirming your employment status as a security guard can be beneficial, especially if you have been employed for more than 90 days.
  • Payment Information: If you choose to pay by credit card, you will need to include your credit card information on the renewal form, including the cardholder's name and signature.
  • Identification Documents: A valid photo ID, such as a driver’s license or non-driver ID, may be required for verification purposes during the renewal process.
  • Retirement Option Election Form: For those considering retirement, it's important to understand the NYCERS F552 form, which can be reviewed at nytemplates.com/blank-nycers-f552-template/ to know the implications of the pension payment options available.
  • Affirmation Statement: A signed statement affirming that all information provided is true and correct is required. This is included in the DOS 1246 form but is a critical component of the renewal process.

Gathering these documents ahead of time can help ensure that your renewal application is processed without delays. Always check for the latest requirements, as regulations may change. Being prepared will make the renewal process smoother and more efficient.