ShowForm - Sheriff Finger Print Application

REQUEST FOR LIVE SCAN SERVICE

You have 20 minutes to complete this form

Asterisk (*) indicates a required field

Do not use punctuation marks (commas, periods, slashes, etc.)

Application Type


*	Type of Application:
*	Agency ORI Code	(Code assigned by DOJ)
*	Job Title or Type of License, Certification or Permit

Agency Address Set Contributing Agency


*	Agency authorized to receive criminal history information:	(Agency Name)		*	City:
	Mail Code:	(5 digit code assigned by DOJ)		*	State:
*	Street No.:			*	Zip Code:	4Code
*	Street Name or P.O. Box#:				Contact Name:	(Mandatory for all school submission)
	Suite No.:				Telephone No.:	- - Ext:

Applicant Information


*	Last Name:				Social Security No.:	- -
*	First Name:				CA Driver License No.:
	Middle Name:			*	Agency Billing No.:	(If there is no billing information, enter NA. If "Collect All Fees" is printed on your form – enter CAF.)
	Jr., Sr., III:				Misc No.:	-
	Alias Last Name:				Misc No.:	-
	Alias First Name:				Home Address
	Alias Middle Name:			*	Street No.:
	Alias Jr., Sr., III:			*	Street Name or P.O Box#:
*	Date of Birth:	/ / (MM/DD/YYYY)			Apt. No.:
	Sex:	Male Female		*	City:
*	Height	Ft. In.		*	State:
*	Weight:	Lbs.		*	Zip Code:	4Code
*	Eye Color:			*	Telephone No.:	- - Ext:
*	Hair Color:				Send confirmation email to
*	Place of Birth - Country:				Email:
	Place of Birth - State:				Confirm Email:


	Your OCA Number:	(Agency Identifying/Facility/License No.)
	ONLY required if your ORI is A0448


*	Level of Service:	DOJ: Yes No Required - Click Yes or No
		FBI: Yes No Required - Click Yes or No