Join Online Now First Name: * Middle Name or Initial: * Last Name: * Business or Agency Name: Agency License Number: * Expiration Date Agency License: (MM/YYYY) Date of Birth: 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 20142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920191919181917191619151914191319121911191019091908190719061905 Business Street Address: * Business P. O. Box: Business City: * Business State: * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming –U.S. Territories– American Samoa Federated States of Micronesia Guam Midway Islands Puerto Rico U.S. Virgin Islands Business Zip Code: * Business Phone Number: * Cell Number: Toll Free Phone: Fax Number: Website Address: E-mail Address: * Comments or Questions: > Are you licensed as a Private Investigator in any other state(s)? * YesNo If yes, please list those other states and license numbers: Have you ever had your private investigator license suspended or revoked in Iowa or any other jurisdiction? * YesNo If yes, please explain. Have you ever been convicted of any offense described in Chapter 80A.4 of the Code of Iowa? * YesNo If yes, please explain. Would you like to serve on an IAPI Committee? * YesNo If yes, which one? Please check any specialties that apply: Accident ReconstructionArson InvestigationAsset ChecksAuto/Truck/MotorcycleAviationBackground ChecksBank & Accounting FraudBoatingCell Phone Analysis/ ForensicsChild Custody / AbuseCollectionsComputer ForensicsCorporate InvestigationCriminal InvestigationCivil InvestigationDebugging/ SweepingDrunk Driving DefenseDocument ExaminationDomesticDrugsElectronic SurveillancePre-employment ScreeningExplosives/ FirearmsFraudIndustrial AccidentsInsurance InvestigationInterpreting / SpanishGeneral InvestigationIdentity FraudMalpractice/ MD/ LegalMortgage FraudMaritimeMissing PersonsMissing Persons / Adoption SearchPatrolPhotographyPersonal InjuryPolygraph/ Voice StressProcess ServiceProbate / Missing HeirsProduct LiabilityPatent/ Trademark InfringementRailroadRecords ResearchRepossessionsSecuritySkip TraceStatementsSurveillanceSwimming/ Scuba AccidentToxic Hazardous WasteTrial PreparationVideoWhite Collar CrimeWrongful DeathWorkers CompensationOther – List below Other Specialities: * Required
