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Name________________________________________________________________
Employer/Agency/Company/Address_______________________________________
Position/Job Title:___________________________
Active Law Enforcement Yes
__
No __
Bus Street
Address:_________________City_____________State___________Zip___________
Home Street
Address_________________City_____________State___________Zip_________
Home Telephone_____________________BusinessTelephone________________________
Cell________________________________Fax_____________________________________
Social Security #____________________________
Date of Birth_______________________
Ky PI License # _____________________________
First Issue Date of License in Kentucky ______________
Other PI License that you may have :
Number and State _____________________________________
Are you license in good standing Yes ____ No___
E-Mail Address____________________________
WEB SITE___________________________
Years with current employer___________
Years in Law Enforcement, PI, Security, etc._______
Years as a Private Investigator ______________
TYPES OF KSPI MEMBERSHIP:
FULL
MEMBER. Full membership shall be open exclusively to those
individuals who shall have state issued private
investigators license.
ASSOCIATE MEMBER. Associate Membership shall be opened to
those who fail to meet the requirements for full
membership.
STUDENT MEMBER. Student Membership shall be opened to
students enrolled in a Criminal Justice, Police Science,
Law School or related program in an accredited college or
university.
AFFILIATE MEMBER. Affiliate Membership shall be for those
individuals with no investigative experience and who do
not serve as an investigative practitioner. It shall also
be opened to organizations of any type who shall support
the Society’s purposes for its foundation and the
betterment of the community-at-large. Such membership
shall not be upgraded.
THE FOLLOWING QUESTIONS MUST BE ANSWERED:
Have you ever been convicted of a Felony? Yes __ No __
Misdemeanor? Yes __ No __
Violation, other than Traffic? Yes __ No __ Federal Crime?
Yes __ No __
Has any License or Professional Certification ever been
Suspended or Revoked? Yes __ No __
Have you ever been Expelled from a Professional, Fraternal
or Trade Organization? Yes __ No __
Have you ever been a Defendant in a State or Federal Civil
Suit? Yes __ No __
If accepted for KSPI Membership, I would like to VOLUNTEER
for a Committee? Yes __ No __
IF YOU ANSWERED YES TO ANY OF THE ABOVE, PLEASE EXPLAIN ON
A SEPARATE PIECE OF PAPER
I
would like to be listed on the KSPI Web Directory for
FREE? Yes __ No __
I
hereby apply for membership in The Kentucky Society of
Professional Investigators. I have completed the application and attached any additional
documentation requested herein. I have attached either a
check (call for credit card payment). I agree to pay a
non-refundable application fee of $30.00, plus annual dues
of $50.00. Thereafter, annual dues are due no later than
one year from acceptance. I hereby Affirm that all
statements made herein are true and correct to the best of
my knowledge and I authorize and release The Kentucky
Society of Professional Investigators, Officers,
Directors and Agents to conduct an investigation to
determine the truthfulness of my statements and claims if
deemed necessary.
Signature____________________________________
Date________________________
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