Fingerprint Consent Form
Applicant Information
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Were you convicted to a crime in the past?
Yes
No
Do you have any pending arrest charges?
Yes
No
Upload a screenshot of your IDs
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of
Consent & Authorization
The purpose of this consent form is to explain the reason why we need to do a fingerprint scan to verify your identity. This is also to conduct a background check, criminal records check, or reports.
I consent that my fingerprints being taken by this organization and use it to verify my records or dispute a legal document.
I understand that I have the right to review, obtain, and seek correction for any inaccuracy with my records.
I understand that this document is considered strictly confidential.
I agree to provide 2-3 IDs as a supporting document.
I confirm that all information I provided is accurate and true.
Signature
Date Signed
-
Month
-
Day
Year
Date
If under 18 years old, the parent or guardian must sign below:
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: