Request For Live Scan Service - Csusb
Download a blank fillable Request For Live Scan Service - Csusb in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Request For Live Scan Service - Csusb with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1REQUEST FOR LIVE SCAN SERVICE
Applicant Submission
ORI: ___________________
Type of Application:
____________________________________________________________________________________
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
Mail Code (five-digit code assigned by DOJ)
Street No.
Street or PO Box
Contact Name (Mandatory for all school submissions)
(
)
City
State
Zip Code
Contact Telephone No.
Name of Applicant:
(Please print)
Last
First
MI
Driver's License No. _________________________________
Alias:
Last
First
Date of Birth: ____________ SEX:
Male
Female
Misc. No. BIL - ________________________________
Agency Billing Number (if applicable)
Weght: _________________
Misc. No.
Height: __________________
Eye Color:
Hair Color:
Home Address:
Street or P.O. Box
Place of Birth: _________________________________
City, State and Zip Code
SOC:
Level of Service
DOJ
FBI
Your Number:
OCA No. (Agency Identifying No.)
If resubmission, list Original ATI No. _______________________
Employer:
(Additional response for agencies specified by statute)
Employer Name
Street or PO Box
Mail Code (five digit code assigned by DOJ)
Street No.
(
)
State
Zip Code
Agency Telephone No. (Optional)
City
Live Scan Transaction Completed By:
Date: ___________________________
Name of Operator
ATI No.
Amount Collected/Billed
Transmitting Agency
ORIGINAL-Live Scan Operator; SECOND COPY-Requesting Agency; THIRD COPY-Applicant
BCII 8016 (Rev04/01)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business