Private Investigations Advisory Board
RENEWAL APPLICATION
FOR SECURITY GUARD LICENSES
Licensee Information
Individual License Type (select one)
Security Guard – Level 1
Security Guard – Level 2
Security Guard – Level 3
License Number License Expiration Date
Last Name First Name
Middle Name Date of Birth
name change requires official documentation, such as a marriage certificate, be submitted with this application
Primary Phone Number Mobile Phone Number
Primary Email Address
Primary Mailing Address
City State Zip code
this is an official address where license and legal mail is sent and licensee must check and keep current
Renewal Application Details (select one)
The Department is transitioning to 3-year license terms. Renewals through 2023 are staggered by even and odd
license numbers for 2 and 3 year terms, until January 1, 2024 when all renewals will be for 3-year terms
Renewal
Level 1 & 2 Fee = $50.00 for even license numbers (2 year term)
$75.00 for odd license numbers (3 year term)
Level 3 Fee = $100.00 for even license numbers (2 year term)
$150.00 for odd license numbers (3 year term)
Late Renewal
Fee = Renewal Fee Above Plus $100.00 Late Fee
required if submitted or postmarked after expiration date
Have you worked in the regulated industry while this license was
expired, also referred to as unlicensed practice?
No Yes
Licenses not renewed by expiration date will expire and the individual cannot practice the
profession. For up to thirty (30) days after expiration, a license may be reinstated by submitting
a renewal application with payment of a late fee. Unless a license is placed on inactive status, a
license expired for more than thirty (30) days may not be renewed or reinstated. Practicing
without an active license is a violation of New Mexico law and subject to disciplinary action and
fine of up to $1,000 for each occurrence.
Renewal Application
Boards and Commissions Division | Private Investigations Advisory Board
P.O. Box 25101 | Santa Fe, NM 87504
(505) 476-4650 | rld.nm.gov
Employment Information
Employer Business Name
Business Physical New Mexico Address
Business City State Zip code
Renewal Questions
1. Since your last renewal, do you understand and have you complied with all continuing
education requirements to renew your license, including completion of 2 hours of
continuing education credit per year?
No Yes
proof of completion of continuing education (e.g. certificate of completion or other formal
documentation) must be submitted with this renewal application (continuing education
requirements are waived for the first renewal)
2. Since your last renewal, has any license you hold in this profession been denied,
suspended, revoked, or otherwise disciplined by a licensing board in any state or
jurisdiction?
No Yes
if yes, submit an explanation in writing with a copy of any disciplinary documents, such as a
final decision and order or settlement agreement
3. Since your last renewal, have you been convicted of a felony that may be considered
potentially disqualifying to obtain or hold a license with the Department? A list of
potentially disqualifying convictions may be found in Board Rule 16.48.9.14 NMAC.
No Yes
if yes, submit an explanation in writing with a copy of any final judgment, settlement, plea, or
other document with sufficient details of the criminal conviction. A disqualifying criminal
conviction will not prevent the renewal of a license but may be reviewed separately by the Board
and Department to determine if additional investigation or action is necessary.
4. It is required to provide a passport type photograph with your renewal (headshot
facing forward with no sunglasses or headwear). Have you included this photograph
with your renewal application or emailed a copy to Department staff at
pipolygraphbd@state.nm.us?
No Yes
Renewal Application
Boards and Commissions Division | Private Investigations Advisory Board
P.O. Box 25101 | Santa Fe, NM 87504
(505) 476-4650 | rld.nm.gov
5. [FOR LEVEL 3 ONLY] It is required for a Level 3 Security Guard to complete a
background check and submit a DPS Authorization for Release of Information directly
to the New Mexico Department of Public Safety (form included below) prior to
submitting the renewal application. Have you completed this form and mailed it with
requirement payment to the Department of Public Safety prior to submitting this
application?
No Yes Not Applicable
if no, your application is considered incomplete and will not be processed – do not submit your
application before completing this requirement if renewing a Level 3 Security Guard license
6. [FOR LEVEL 3 ONLY] It is required for a Level 3 Security Guard to complete a
firearms qualification every renewal cycle and submit the required documentation on
a firearm certification form completed by a Level 3 Instructor approved by the
Department (the required form is provided to all Level 3 Instructors). Have you
completed this requirement and included a copy of the firearm certification form with
this application?
No Yes Not Applicable
if no, your application is considered incomplete and will not be processed – do not submit your
application before completing this requirement if renewing a Level 3 Security Guard license
Please ensure to include copies of any written explanation or additional documents required
related to the questions above with your renewal application submitted to the Department.
Attestation
Under penalty of perjury, I declare and affirm that the statements made, and information
provided in the foregoing application, including documentation, are true, complete, and
correct. I understand that any false or misleading information in connection with my renewal
application may be cause for discipline, up to and including loss of licensure.
Signature Date
Renewal Application
Boards and Commissions Division | Private Investigations Advisory Board
P.O. Box 25101 | Santa Fe, NM 87504
(505) 476-4650 | rld.nm.gov
Submission of Renewal Application
Mail the signed and complete renewal application, payment, and any other required
documents to the Department at
Boards and Commissions Division
c/o Private Investigations Advisory Board
P.O. Box 25101
Santa Fe, NM 87504
Payment can be made by check, money order, or cashier check and made payable to
Private Investigations Advisory Board
Questions regarding the application may be directed to Department staff at
pipolygraphbd@state.nm.us
505-476-4650
[LEVEL 3 GUARDS ONLY]
1. Complete the “Release of Information” form (next page), sign, and return to the Department with
the rest of this application
2. Complete the DPS “Authorization For Release of Information” form (after the next page) and
send directly to DPS at the address below prior to or the same time as submitting this renewal
application.
• Mail to: Department of Public Safety, P.O. Box 1628, Santa Fe, NM 87504-1628\
• Notarize: do not sign until with a notary public
• Payment: include a $15.00 check or money order payable to the “Department of Public
Safety” with form mailed to DPS
• The Department of Public Safety will send the results directly to the Regulation and
Licensing Department, which may take several weeks to process but will not delay a renewal
DEPARTMENT USE ONLY
Check or Money Order #
Receipt #
Processed By
Processed Date
Renewal Application
Boards and Commissions Division | Private Investigations Advisory Board
P.O. Box 25101 | Santa Fe, NM 87504
(505) 476-4650 | rld.nm.gov
RELEASE OF INFORMATION
Complete and submit this form only for Level 3 Security Guard renewals as required to complete a background review
Print or Type Clearly
I, , ,
Last Name First Name Middle Name
Date of Birth
Currently residing at ,
Street Address City
State Zip Code
Having made application with the Regulation and Licensing Department for licensure by the Private
Investigations Advisory Board under the Private Investigations Act, Chapter 61, Article 27B NMSA
1978, and Rules, Title 16, Chapter 48 NMAC, understand that a comprehensive investigation of my
background may be conducted in connection with this application.
I do hereby give the officials of the Regulation and Licensing Department the authority to conduct any
such investigation. I do hereby authorize the release of any and all information that pertains to my work
history, any criminal history background information, and/or any other information on general
qualifications for fitness to practice as a licensee as requested by this state agency.
I have read, understand, and shall retain a copy of this document for my records.
Applicant’s Name:
Applicant's Signature: Date:
Ma
il to: DEPARTMENT OF PUBLIC SAFETY / P.O. BOX 1628 / SANTA FE, NM 87504-1628
ATTN: RECORDS
Include Payment: $15.00 PER RECORD CHECK
AUTHORIZATION FOR RELEASE OF INFORMATION
I, ___________________________________________________________________________________
NAME (MUST BE PRINTED-LEGIBLY) (SSN #) (DOB)
PURSUANT TO NMSA 1978, SECTION 29-10-6(A) (Repl. Pamp. 1990), OF THE NEW MEXICO
ARREST RECORD INFORMATION ACT, HEREBY APPOINT:
New Mexico Private Investigations Advisory Board
P.O. Box 25101, Santa Fe, New Mexico 87504
AS AN AUTHORIZED AGENT FOR ME FOR THE PURPOSE OF INSPECTING (AND /OR
OBTAINING COPIES OF) ANY NEW MEXICO ARREST FINGERPRINT CARD SUPPORTED
ARREST RECORD INFORMATION MAINTAINED BY THE DEPARTMENT OF PUBLIC SAFETY,
INCLUDING INFORMATION CONCERNING FELONY OR MISDEMEANOR ARRESTS
AND INFORMATION OBTAINED FROM RELEVANT FINGERPRINT DATABASES.
TO THE CUSTODIAN OF THE RECORDS IN QUESTION, I HEREBY DIRECT YOU TO RELEASE
SUCH INFORMATION TO THE AUTHORIZED AGENT AS DESCRIBED ABOVE.
I HEREBY RELEASE THE CUSTODIAN OR CUSTODIANS OF SUCH RECORDS AND THE
DEPARTMENT OF PUBLIC SAFETY, INCLUDING ANY OF THEIR AGENTS, EMPLOYEES, OR
REPRESENTATIVES IN ANY CAPACITY, FROM ANY AND ALL CLAIMS OF LIABILITY OR DAMAGE
OF WHATEVER KIND OR NATURE, WHICH AT ANY TIME COULD RESULT TO ME, MY
HEIRS, ASSIGNS, ASSOCIATES, PERSONAL REPRESENTATIVE OR REPRESENTATIVES OF ANY
NATURE BECAUSE OF COMPLIANCE BY SAID CUSTODIAN OR CUSTODIANS WITH THIS
"AUTHORIZATION FOR RELEASE OF INFORMATION" AND MY REQUEST CONTAINED HEREIN
FOR THIS RELEASE OR BECAUSE OF ANY USE OF THESE RECORDS. THIS RELEASE IS BINDING,
NOW AND IN THE FUTURE AND IS VALID FOR A PERIOD OF UP TO 120 DAYS FROM THE DATE
SIGNED, ON MY HEIRS, ASSIGNS, ASSOCIATES, PERSONAL REPRESENTATIVE OR
REPRESENTATIVES OF ANY NATURE.
APPLICANT SIGNATURE: ___________________________________
DATE
: _______________________________
(*ATT
N: NOTARY-ENSURE DOCUMENT IS SIGNED BY BOTH APPLICANT AND PARENT
(GUARDIAN) IN YOUR PRESENCE AND NAME, DOB, SOC INFO IS VERIFIED WITH A VALID ID)
SUBSC
RIBED AND SWORN TO BEFORE ME THIS _______ DAY OF_____________20_____.
(SEA
L) ___________________________.
(NOTARY PUBLIC)
MY COMMISSION EXPIRES: _____________________.
For Department Use Only
