Transcription of BCIA 8016, Request for Live Scan Service
{{id}} {{{paragraph}}}
Example: dental hygienist
BCIA 8016, Request for Live Scan Service
Applicant SubmissionORI (Code assigned by DOJ)Authorized Applicant TypeType of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)Contributing Agency Information:Agency Authorized to Receive Criminal Record InformationMail Code (five-digit code assigned by DOJ)Street Address or BoxCityZIP CodeContact Name (mandatory for all school submissions)Contact Telephone NumberApplicant Information:Last NameFirst Name Middle InitialSuffixOther Name (AKA or Alias)LastFirstSuffixDate of BirthSexMaleFemaleDriver's License NumberHeightWeightEye ColorHair ColorPlace of Birth (State or Country)Social Security NumberHome AddressStreet Address or BoxCityZIP CodeBilling Number(Agency Billing Number)Misc. Number(Other Identification Number)Your Number:OCA Number (Agency Identifying Number)Level of Service : DOJ FBIIf re-submission, list original ATI number: (Must provide proof of rejection)Original ATI Number Employer (Additional response for agencies specified by statute):Employer NameStreet Address or BoxCityZIP CodeMail Code (five digit code assigned by DOJ)Telephone Number (optional) live scan Transaction Completed By:Name of OperatorDateTransmitting AgencyLSIDATI NumberAmount Collected/Billed ORIGINAL - live scan Operator SECOND COPY - Applicant THIRD COPY (if needed) - Requesti
Title: BCIA 8016, Request for Live Scan Service Author: California Department of Justice, California Justice Information Services Division, OSP Subject
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: