Licensees must submit employee rosters to the Department on a quarterly basis.

Note:  A renewal application shall not be processed if the quarterly roster has not been received for each quarter of the preceding 2-year license period. Authority MCL 338.1067(3)

Quarterly rosters are due at the end of each quarter as shown below:

You may use the following form: [Click Here]Or you may use your own company roster form as long as it has the required information listed below.  Double-sided rosters are preferred for multiple page reports.

Rosters must contain the following information:

• Agency name
• Agency license number
• Agency address and telephone number
• Name of the License Holder
• Name of person preparing report, their title and signature
• Alphabetical listing of employees that have been employed by your agency for the quarter.  Employees are classified as follows:
  • Human Resource employees
  • All employees that are hired to provide the protection of property on the premises of others
• Employee date of birth
• Employee hire date
• Employee termination date
• Total number of employees for the quarter
• Quarter covered by the report
• SWORN STATEMENT as follows: I affirm that I am authorized to act on behalf of the above named agency and I verify that the information contained on this form is true, complete, and accurate to the best of my knowledge and belief.  (Print Name of Person Preparing Report, Signature, Title, and Date)

§         You are required to file a roster form for each branch facility.

§         A roster is required even if your company does not have any employees.  Documentation must indicate "No Employees" or list "0" under the area marked Number of Employees.