First Name
*
Last Name
*
Email
*
Phone
CA DOJ Assigned ORI Number:
Does your organization have a Request for Live Scan Service form (BCIA 8016) from the CA DOJ?: If yes, please attach a copy.
Address of the event:
Exact location where fingerprinting will take place (outside, inside, in a specific classroom or office - please provide number, etc.):
Contact person and phone number for the individual who will be present at the event:
Event Date:
Event time frame (2-hour minimum required):
Number of applicants/volunteers to be printed (minimum based on location):
Special instructions for parking or designated parking spot:
Additional instructions or information:
Who will we be collecting payment from?
Each Applicant
Organization
Other
If collecting from organization, which method of payment will be used? The credit card authorization form or the ACH form emailed to you will need to be completed and returned.
Credit Card
EFT
ACH
Check
CLS will need access to a table, chair and a power outlet. Can you please confirm this will be available?
Yes
No
Will there be signs directing people to the fingerprinting location? Please explain:
Submit