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Fingerprint Applicant Form

First Name *

Middle Name

Last Name *

First Name

Middle Name

Last Name

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Email Address *

Phone *

Date of Birth *

City of Birth *

State or Country of Birth *

Sex *FemaleMaleOther

Hair Color *

Eye Color *

Height *

Weight *

Is the applicant directly responsible for the safety and welfare of the children being supervised? (This includes all clergy, teachers, coaches and principals. Also, parent volunteers who are alone with children such as librarians.) *YesNo

Is the applicant supervising children in a licensed pre-school? (This includes baby-sitters supervising children ages 7 and below and/or children with special needs, and those people involved in pre or post Day Care.) *YesNo

Has the applicant moved to California from other states within the last ten years? *YesNo

Is the applicant a paid employee? *YesNoAnswering 'Yes' to this question will incur a California Department of Justice charge, which will be billed to the parish/school.

Specify Paid Staff/Employee Job Title

Specify Volunteer/Ministry

Service Level (if any):DOJFBI

Applicant Signature *