General Information
PLEASE TYPE OR PRINT CLEARLY
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All private investigators must notify the Department within 10 calendar days of any change of address by
completing a Private Investigator Change of Information form (PI-23).
First Name:
Middle Initial:
Last Name:
*Social Security Number:
Driver’s License Number/State:
Previous Name(s):
Race (Optional):
Country of Citizenship:
Legally able to work in U
S
?
African American
.
.
YES
Hispanic
Asian/Pacific Islander
NO
Caucasian
Native American
Height:
Weight:
Hair Color:
Eye Color:
Gender:
Date of Birth:
E-mail Address:
Highest level of education:
Do you have the required 1500hrs of experience?
YES - please attach documentation
NO
Home Phone:
Work Phone:
Cell Phone:
Home Address:
City:
State:
Zip Code:
County:
Mailing Address (If different):
City:
State:
Zip Code:
County:
*You are required to provide their Social Security Number (SSN) to DPSST. The authority for this requirement is ORS 25.785, ORS 305.385, 42 USC
405(c)(2)(C)(i) and 42 USC 666(a)(13). Your SSN will only be used for child support enforcement and tax purposes. Failure to provide your SSN will be basis to
refuse issuance of a license or certification.
Request for Orientation and Exam
Information will be sent to your email address no later than one week before class starts. Applicants are
responsible to adhere to the dress code given in the materials. For orientation and exam availability please
visit our PI Training Calendar on our website:
I am requesting the orientation and exam on _________________________________________________.
If the orientation/exam date I am requesting is full, please schedule me for _______________________ .
Your email will now be used as our form of communication for all correspondences regarding your application
process.
Additionally, please check yes
if you would like to be added to our email messaging system regarding other updates to the
E-mail Address:
investigator program.
PI-1 Application for Licensure
Revised: 11/2016
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