Applicant Registration and Information Form

 

This form does not need to be turned in at the fingerprint site.  It is designed only as a tool to help facilitate your registration and payment for fingerprinting services.

 

Printable PDF

 

 

 

 

 

 

 

ABID

Needed only if employer is to be billed

 

ABID Password

 

 

 

 

Reason Fingerprinted (Choose One)

School District, Intermediate Unit, Area Vocations Technical Schools (AVTS), Non-Public Schools, Private, College/Universities, Charter Schools

 

 

 

 

 

 

Payment Type

 

Applicant

 

Agency Pay (Requires ABID Number)

 

 

 

 

 

 

 

 

Last Name

 

First Name

 

Middle Name

 

 

 

 

 

 

 

 

 

 

Date of Birth

 

Place of Birth (state)

 

SSN

 

 

 

 

 

 

 

 

 

 

Sex

 

M

 

F

Race

 

Eye Color

 

Hair Color

 

 

 

 

 

 

 

Height

 

Weight

 

Country of Citizenship

 

 

 

 

 

 

 

Drivers License Number

 

 

 

 

 

 

 

 

 

 

 

Applicant Address

 

 

 

 

 

 

 

 

 

 

 

City

 

State

 

Zip

 

 

 

 

 

 

 

Phone