Fingerprinting Form | City of Oberlin Police Department

Request for a Background Check via Electronic Fingerprinting

BCI

FBI

BCI & FBI

Type of Photo ID & ID #

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone Number

Date of Birth

SSN

Complete this portion only if an FBI background check is needed:

Sex

Race

Height

Weight

Eyes

Hair

Reason For BackgroundCheck

FBI Reason Code

BCI Reason Code

Mail results to: Company Name

Attn Name

First Last

Phone Number

Address

Street Address Address Line 2 City State ZIP Code

Direct Copy to

I certify that the personal identifiers provided on this form are accurate and I voluntarily and knowingly authorize the Ohio Bureau of Criminal Investigation and/or the Federal Bureau of Investigation to conduct a criminal records check for the information relating to me. I also voluntarily and knowingly authorize BCI to disseminate criminal conviction and juvenile delinquency adjudication records to

Signature

I voluntarily and knowingly release and discharge the Ohio Attorney General's Office, BCI, the FBI a and their employees from all claims and liability related to this authorized criminal record review and dissemination.

Applicant's Name

First Last

Witness Name

First Last

Applicant's Signature

Witness Signature

Parent/Guardian Name

First Last

Parent/Guardian Signature (Minor Applicants Only)

By signing this form the applicant acknowledges that all information on this form is accurate. Any mistakes or errors on this form are the responsibility of the applicant.

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