Lock
smith Company Employee R
egistration
Priv
Priv
ate Investigator License
Priv
ate Patrol Live Scan Form
Priv
ate Patrol Operator
Private Patrol Operator License w/Firearm Permit
Private Security Live Scan Form
Proprietary Private Security Officer Registration
Repossession Company Live Scan Form
Repossession Agency License
Repossession Agency Qualified Manager Certificate
Repossession Agency Employee Registration
Security Guard Live Scan Form
Security Guard Registration
Security Guard Registration w/Firearm Permit
Firearms Permit Initial Application
Firearms & Baton Live Scan Fingerprinting Form
Training Facility Firearm Certification
Training Facility Baton Certification
Training Instructor Baton Permit
Training Instructor Firearm Permit
Other Firearm & Weapon Live Scan Form
Entertainment Firearms Permit Application & Live Scan Form
Military Assault Weapon Permit Application
Dangerous Weapons License/Permit(s) Application
Dental Board of California Dental License Live Scan Form
Licensed Dentist Live Scan Form (DDS)
Dental Licensure by Credential Live Scan Form (LBC)
Dental Licensure by Residency Live Scan Form (LBR)
Western Regional Examining Board Form (WREB)
Registered Dental Assistant Live Scan Form BCII 8016 (RDA)
Registered Dental Assistant in Extended Functions Live Scan Form (RDAEF)
Registered Dental Hygienists Live Scan Form (RDH)
Live Scan Form for Orthodontic Assistant (OA)
Live Scan Fingerprinting Form for Dental Sedation Assistant (DSA)
An Oral and Maxillofacial Surgery Permit Fingerprint Application
Live Scan Application Form for Dental License Renewal
Criminal Record Review / Foreign Adoption
Criminal Record Review (Personal Use)
Foreign Adoption
Contractors State License Board
Contractors State License Board Information
Department of Motor Vehicles (DMV)
Ambulance Driver Certificate
er
Business Partner Automation
Dealer License
Dismantler/Wrecker Lice
nse
Distributor License
Distributor Representative License
Driving School Instructor License
Driving School Operator License
Driving School Owner License
Lessor/Retailer License
Manufacturer License
Manufacturer Representative License
Registration Service License
Salesperson License
Transporter License
Traffic Violation School Owner/Operator/Instructor License
Vehicle Verifier Permit
Department of Real Estate (DRE)
Real Estate License Live Scan Form – RE 237
Department of Social Services
Trust Line Live Scan Form – A1157
CA Dept of Social Services – LIC 9163
Education
Applicant for Teacher Credential
Financial
Check Cashers Permit
Deferred Deposit Transaction Law License
Department of Corporations
Department of Corporations Finance Lender License
Escrow Agents License
Mortgage Banker License
Gambling
Gambling Card Room Key
Gambling Card Room Owner
Gambling Card Room Work Permit
Gambling Third Party
Tribal Gaming Key Employee
Tribal Gaming Vendor
Healthcare / Medical / Psychological
Acupuncture Board
Board of Behavioral Sciences:
Board of Optometry
Chiropractic
Doctor of Podiatric Medicine
Naturopathic Doctor
Registered Nurse Live Scan Form – Endorsement (DOJ + FBI)
Registered Nurse Live Scan Form – Examination (DOJ + FBI)
Vocational Nurse or Psychiatric Technician
Pharmacists
Pharmacy Intern
Pharmacy Technician
Pharmacy Wholesaler
Physical Therapist or Physical Therapist Assistant
Psychology
Respiratory Care Practitioner
Speech-Language Pathology and Audiology Board
VISA / IMMIGRATION
/P
Secretary of State Immigration Co
nsu
ltant
GAMBLING RELATED
Gambling card room owner
Gambling card room key
Gambling card roo
m work pe
rmit
Gambling third party
Tribal gaming key employee
Tribal gaming vendor
Legal Industry
California State Bar Determination of Moral Character
Identity Theft Live Scan Request form
Notary Public Live Scan Form – SOS
Pest Control
DCA / Structural Pest Control Board
Miscellaneous
Board of Occupational Therapy, DCA
Cemetery and Funeral Bureau
Electronic Recording Delivery System (ERDS Program)
Emergency Medical Agency EMT-I Certification – Santa Barbara
Emergency Medical Agency EMT-I Certification – LA County
Emergency Medical Agency EMT-I Certification – Orange County
Professional Fiduciaries Bureau
Victim of Identity Theft
Identity Theft Live Scan Request form
More Forms Below
California DMV Services
CA Dept of Social Services
Trust Line Live Scan Form
CA Commission on Teaching Credentialing
Check Cashers Permit – Live Scan form
Certified Nurse Assistant (CNA) & Home Health Aide (HHA)
DMV-8016 – Live Scan request form
Entertainment Firearms Permit Application & Live Scan Form
Identity Theft Live Scan Request form
Pharmacists Live Scan Form (Pages 15 thru 17)
Pharmacy Wholesaler Live Scan form
Home Improvement Salesperson (HIS) Application
Applicant Submission
ORI (Code assigned by DOJ)
Authorized Applicant Type
Type of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)
Contributing Agency Information:
Agency Authorized to Receive Criminal Record Information
Mail Code (five-digit code assigned by DOJ)
Street Address or P.O. Box
City ZIP Code
Contact Name (mandatory for all school submissions)
Contact Telephone Number
Applicant Information:
Last Name
First Name Middle Initial
Suffix
Other Name
(AKA or Alias)
Last
First
Suffix
Date of Birth
Sex
Male
Female
Driver's License Number
Height
Weight Eye Color
Hair Color
Place of Birth (State or Country)
Social Security Number
Home
Address
Street Address or P.O. Box City ZIP Code
Billing
Number
(Agency Billing Number)
Misc.
Number
(Other Identification Number)
Your Number:
OCA Number (Agency Identifying Number)
Level of Service:
DOJ FBI
If re-submission, list original ATI number:
(Must provide proof of rejection)
Original ATI Number
Employer (Additional response for agencies specified by statute):
Employer Name
Street Address or P.O. Box
City
ZIP Code
Mail Code (five digit code assigned by DOJ)
Telephone Number (optional)
Live Scan Transaction Completed By:
Name of Operator Date
Transmitting Agency LSID ATI Number Amount Collected/Billed
ORIGINAL - Live Scan Operator SECOND COPY - Applicant THIRD COPY (if needed) - Requesting Agency
STATE OF CALIFORNIA
DEPARTMENT OF JUSTICE
BCIA 8016
(Rev. 05/2018)
REQUEST FOR LIVE SCAN SERVICE
(If the Level of Service indicates FBI, the fingerprints will be used to check the
criminal history record information of the FBI)
State
State
State
Fingerprint Applicant Submission
STATE OF CALIFORNIA
DEPARTMENT OF JUSTICE
GENERIC LIVE SCAN FORM
Applicant must contact their Contributing Agency to verify the accuracy of the form required for their Live Scan submission.
