Transcription of BCIA 8016RR - REQUEST FOR LIVE SCAN - Attorney General of ...
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BCIA 8016RR - REQUEST FOR LIVE SCAN - Attorney General of ...
Applicant SubmissionORI (Code assigned by DOJ)Type of Application (Check One Only)Record ReviewForeign AdoptionReason for ApplicationContributing Agency Information:Agency Authorized to Receive Criminal Record InformationStreet Address or BoxCityStateZIP CodeMail Code (five-digit code assigned by DOJ)Contact Name (mandatory for all school submissions)Contact Telephone NumberApplicant Information:Last NameFirst NameMiddle InitialSuffixOther Name (AKA or Alias)LastFirstSuffixDate of BirthSexMaleFemaleDriver's License NumberMisc. Number (Other Identification Number)HeightWeightEye ColorHair ColorPlace of Birth (State or Country)Social Security NumberTelephone NumberStreet Address or BoxCityStateZIP CodeLevel of Service: DOJ OnlyIf re-submission, list original ATI number (Must provide proof of rejection):Original ATI NumberForeign Government Embassy: (Mandatory for Foreign Adoption requests pursuant to Penal Code section 11105(c)(12))Designee -- Do not include Employer: (Optional for individual designated by applicant pursuant to Penal Code section 11124)Designee or Embassy NameStreet Address or BoxCityStateCountryZIP CodeTelephone Number Live Scan Transaction Completed By:Name of OperatorDateTransmitting AgencyLSIDATI NumberAmount Col
In order to process applications pertaining to Live Scan service to help determine the suitability of a person applying for a license, employment, or a volunteer position working with children, the elderly, or the disabled, we may need to share the information you give us with authorized applicant agencies.
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