Non-Criminal Justice Requisition For Applicant Fingerprint Cards And Forms - North Carolina Bureau Of Investigation

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NON-CRIMINAL JUSTICE REQUISITION FOR APPLICANT
FINGERPRINT CARDS AND FORMS
Please use this form to order your fingerprint cards.
Forward to
NC State Bureau of Investigation
:
Criminal Information & Identification Section
Post Office Box 29500
Raleigh, NC 27626-0500
Email to:
CIISHelp@ncsbi.gov
Fax To:
(919) 661 - 4890
Form Number
Description
Quantity
FD–258
Applicant Fingerprint Card
Federal Fingerprint Card: Public Law 105.277
Licensed/Certified Direct Patient Care
* Order only if approved for use of ORI NC…..C9Z *
Standard Criminal State and/or Federal Background Check
Federal Fingerprint Card: SB41–2005
* * For all other uses: ORI NC…..00 * *
Date:
Agency Name:
Street Address
:
(not P.O. Box)
City:
, NC
Zip:
Contact Person :
Phone:
Enter with Punctuation
Include Area Code
Ex: (123) 456-7890
If you should have any questions regarding this order, call (919) 582-8660.
Please allow up to two weeks for delivery of supplies.
For SBI Use Only
For SBI Use Only
Date Received: __________________
Date Processed: ___________________
: EMAIL ― DCI ― US MAIL ― PHONE ― FAX
RECEIVED VIA
(circle one)
Received By: ____________________
Processed By: ____________________
Rev. 11/09/2016

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