Licensed Private Detectives Association of Rhode Island
       Post Office Box 7583, Warwick, Rhode Island 02887
               (401) 952-2182 ▪ Fax (401) 732-9802
                             www.LPDARI.org


APPLICATION

 

Note: Please read carefully and fill in all blanks. Use additional sheets if needed.  Mail application to the above address.

Application must be accompanied by a check or money order, for $50.00, (annual membership dues), payable to L.P.D.A.R.I., A copy of your current Private Detective License (s).

In the event applicant is not approved for Active/Associate Membership, the Annual dues will be refunded.  Upon acceptance, you will receive a L.P.D.A.R.I. Membership Card.

NOTE: Individuals not licensed in Rhode Island are eligible for Associate Membership ($25.00 Annual Dues)

PLEASE TYPE OR PRINT:

1. Full Name of Applicant__________________________________________________________________

2. Legal Residence Address________________________________________________________________

_____________________________________________________________________________________

3. Phone Number (Home): ______/_______/_______   (Office) _______/_______/_______

 List your residence telephone in membership directory?  Yes______  No______

4. Date of Birth: ______/______/______

5. Agency Name_________________________________________________________________________

6.Agency Address(s)________________________________________________________

___________________________________________________________________________

7. Agency Telephone  (Day):______/______/______ (Night)______/______/______

8. Pager/Cell:______/______/______ Fax:______/______/______  

E-Mail:________________   Web Site: www.___________________________________

9. Types of investigations you handle______________________________________
___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

10. Have you ever been convicted in any criminal proceedings? _____________

If your answer is "Yes", Explain:__________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

11. Have you ever been denied a license ________ License suspended ________ 

revoked _______. If yes to any of these please explain:____________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________  

12. If accepted into membership, do you agree to abide by the By-Laws and Code

of Ethics of the Licensed Private Detective Association of Rhode Island (L.P.D.A.R.I.)?

____________

13. Do you authorize representatives of L.P.D.A.R.I., to make a thorough investigation

of the statements concerning your application as contained herein? _______________

14. Do you currently hold a valid Investigator's License as per the General Laws 

of the State of Rhode Island Chapter 5-5? ____________

15. Are you licensed as a Private Investigator in any other State(s)? _____,

If so, where? State ______ Lic.# ___________ State ______ Lic.# __________



WAIVER

I give full consent to the L.P.D.A.R.I., its officers, members and/or their agents, to investigate this application and inquire into my reputation, character and fitness for membership into the L.P.D.A.R.I..  I hereby release the above named organization, its officers, members and/or agents from all liability, claims, injuries (implied or actual) in matters emanating from such investigations, decisions or recommendations.

 

_________________________________________________
Printed Name & Date                                                                                              


_________________________________________________
Signature