DO NOT USE THIS FORM FOR A REAL SITUATION - IT IS ONLY FOR DEVELOPMENT.

Level II Background Check

Please complete this form entirely.

*** YOU WILL BE REQUIRED TO VERIFY ACCURACY WITH THE LATENT SPECIALIST PRIOR TO FINGERPRINT TRANSMISSION. PLEASE BE CAREFUL WHEN CONFIRMING AS TRAMISSION WITH ERRORS RESULT IN DUPLICATE CHARGES.***

Level II Background Check

OCA# (This is for DCF and APD Regulatory Agencies Only)
Company / School / Organization Name/ License Type:
ORI#

If you do not know the ORI please contact the requesting company/ school/ licensing department etc.
Name Name First Middle Last
Name Change Background Check:
(*Please separate all names with a comma.*)

IF BACKGROUND CHECK IS FOR NAME CHANGE PLEASE ENTER YOUR NEW NAME FOLLOWED BY ANY OTHER PREVIOUS LEGAL NAMES
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
D.O.B D.O.B / MM / DD YYYY
State of Birth:

If you were born in a different Country, enter it here.
Gender (Federal government options are Male or Female only at this time)
Race/Ethnicity
Eye Color
Hair Color
Height

Example: 6' 2"
Weight (Approximate weight)
Contact Phone# Contact Phone# - ### - ### ####
Email
Confirm

Confirm I hereby certify that the information contained herein is true and accurate to the best of my knowledge. *** YOU WILL BE REQUIRED TO VERIFY ACCURACY WITH THE LATENT SPECIALIST PRIOR TO FINGERPRINT TRANSMISSION. PLEASE BE CAREFUL WHEN CONFIRMING AS TRAMISSION WITH ERROR RESULT IN DUPLICATE CHARGES.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Type the letters you see in the image below.

Florida FDLE Livescan – $125

Level II Background Check

Level II Background Check

Level II Background Check