Secure Fingerprinting and Background Checks

Demographic Information

Required for Submission to FDLE

ORI Number:

Employment/License Type:

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PERSONAL INFORMATION **REQUIRED**

Phone Number:

Email Address:

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ENTER YOUR NAME EXACTLY AS IT APPEARS ON YOUR ID

Last Name:

First Name:

Middle Name or Initial:

Social Security Number:

Date of Birth:

Place of Birth: (Where were you born?)

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PHYSICAL DESCRIPTORS **REQUIRED**

Gender

Race:

Eye color:

Hair Color:

Height:

Weight:

Country of Citizenship

Address (Where do you currently live?)

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MISCELLANEOUS ID *Only if Requested by Employer

Type of ID:

ID Number:

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EMPLOYMENT *Only if Requested by Employer

Occupation

Employer Name:

Employer Address:

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