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L.A.W. Livescan Consultant, LLC
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Livescan Pre Registration Application
APPLICANT INFORMATION
Please type or print legibly.
First name
*
Last name
*
Date of Birth
Month
Day
Year
Social Security Number:
Gender:
Male
Female
Height in ft. in.
Weight in lbs.
Eye Color:
Hair Color:
Race/Ethnicity:
Black
White
Asian/Pacific Islander
Native American
Other
Place of Birth:
Citizenship:
Multi-line address
Country/Region
Address
City
Zip / Postal code
Phone Number:
Email Address:
*
Driver’s License Number:
REASON FOR REQUEST
INDIVIDUAL
LEAVE BLANK / DO NOT COMPLETE / STOP HERE
Please select one of the following:
Gold Seal/Adoption (Enter Authorization Number if applicable)
Gold Seal/Letter/VISA
Immigration/VISA Individual Challenge
Individual Review
Attorney/Client (Written Authorization Required)
Mailing Information:
Mailing Information:
Country/Region
Address
City
Zip / Postal code
AGENCY
Please select from the following (*ORI Required):
*
Adult Dependent Care
Child Care
Criminal Justice
Government Employment
Government Licensing or Certification
Maryland State Police Licensing
Private Party Petition
Public Housing
CCW
HQL
Security
Private
Special Guard
Detective
Police
Security Systems
Agency Authorization Number:
ORI Number:
*
Position Applied:
*
Apply Now
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