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DCJS 3222 (February 2016)

New York State Division of Criminal Justice Services

SECURITY GUARD PROGRAM – SECURITY GUARD CLASS ROSTER / NOTIFICATION OF SUCCESSFUL COMPLETION
THIS FORM IS USED TO SUBMIT NAMES OF PERSONS WHO SUCCESSFULLY COMPLETED SECURITY GUARD TRAINING
REQUIRED BY ARTICLE 7 OF THE GENERAL BUSINESS LAW §89-N. FORMS PRESENTED FOR FILING MUST CONTAIN
ORIGINAL SIGNATURES. ALTHOUGH THE BLANK FORM MAY BE DUPLICATED, PHOTOCOPIES OF COMPLETED FORMS, OR
FORMS WITH PHOTOCOPIED SIGNATURES WILL NOT BE ACCEPTED. OMMISSIONS OR LACK OF INFORMATION WILL STOP
THE PROCESS.
Within seven days of completion of the class, the form must be forwarded to the Division of Criminal Justice Services, Security
Guard Program. The number of individuals in any class cannot exceed 35.

SECTION I – SCHOOL INFORMATION
Type the information required for each box. The form cannot be processed if any of the information is missing. Record the school
identification number EXACTLY as provided. Incomplete roster