Pursuant to Massachusetts General Law Chapter 147 § 28 "No person shall be employed by any licensee until he shall have executed and furnished to such licensee a statement under oath setting forth his full name, date of birth and residence; his parent's names and places of birth; the business or occupation in which he has been engaged for the three years immediately preceding the date of filing his statement; and that he has not been convicted of a felony or of any offence involving moral turpitude. Such statements shall be kept on file by the licensee and furnished to the colonel of the state police on demand".

Please have the following ready to complete this form:

1. Your employer's company license number, company name, company resident manager's name, and their email address (information, excluding the email, can be found at https://www.mass.gov/certification-unit)

2. Your driver's license number

3. Your firearms license number if applicable (applies to those who will be armed)

Example; "LP0001A" or "LW0001A"
Business/Facility Name
Private Investigator, Watch, or Guard Company Licensee Name or Company Resident Manager Name(Required)
This email address will be used to send a confirmation email to the company

Employee information

Employee name(Required)
Employee driver license state(Required)
Employee address(Required)
Have you ever been convicted of a felony?(Required)
Have you ever been convicted of any offense involving moral turpitude?(Required)
Will you be carrying any of the following items as part of your duties?(Required)
Please check all that apply.

Signature

Agreement
THE ABOVE STATEMENTS ARE MADE UNDER THE PAINS AND PENALTIES OF PERJURY.