Applicant Registration for Department of Welfare

Step 1 - Please Enter Your Information

Transaction Information
Fingerprint Card User   
This box indicates you will be submitting ink rolled cards from out of state or were directed to do so by your requesting agency.
Payment Type
* No unemployment cards, child support cards or gift cards are accepted.
Agency ID
Agency Name
Agency Address
Agency Address2
Agency City
Agency State
Agency Zip
Billing Password (case sensitive)
Reason Fingerprinted *
  (What is it?)
FBI Response Do you authorize the FBI Response to be shared with Authorized Users of this system and their Agents? *
Personal Information
Last Name *
First Name *
Middle Name
Date of Birth (MMDDYYYY)*
Place of Birth City *
Place of Birth *
SSN(no dashes)
Reenter SSN
Sex *
Race *
Eye Color *
Hair Color *
Height *
Weight *
Country of Citizenship *
Driver's License No.
Address *
City *
State *
Zip *
Phone # *
E-Mail Address
Alias Last Name
Alias First Name
Alias Middle Name


Note: Highlighted fields are required and marked by a *.