Livescan Pre-Registration Application Livescan Pre-Registration Application Name * Date of Birth * Social Security Number * Gender * Male Female Height Feet * Inches * Weight Weight (lbs) * Eye Color * Hair Color * Race * Black White Asian/Pacific Islander Native American Other Place of Birth * Citizenship * Current Address Street Address * City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Daytime Phone * Evening Phone Driver's License Number * Agency Information Agency Authorization # ORI # (if required) Reason fingerprinted? Position Applied For Request Type: Adult Dependent Care Attorney/Client Child Care Criminal Justice Gold Seal/Adoption Gold Seal/Letter/Visa Government Employment Government Licensing or Certification Immigration/VISA Individual Challenge Individual Review MSP Licensing Private Party Petition Public Housing Mail Response to: (Mailing option only available for Visa Gold Seal and/or Individual Review) Name Address City State AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip Code reCAPTCHA
