66.
48. Current employer
From: To:
50. Street Address, incl. Apt. No.
49. Employer's name
53. State 54. Postal/Zip code 55. Country
51. City
52. Colonia/Neighborhood
56. Telephone number
Ext.
57. Occupation (attach separate sheet if necessary).
Previous Employer name and address if current employer is less than five years (attach separate sheet if necessary).
58.
From: To:
60. Street Address, incl. Apt. No.
59. Employer's name
61. City
62. Colonia/Neighborhood
65. Country
63. State
64. Postal/Zip code
Have you ever been convicted of an offense in any country?
What country were you convicted in?
If you have answered YES, please give details;
No Yes
No Yes
67.
I certify that all information given on this application, and in support of this application, was provided voluntarily and is true and complete. I understand that any information on
this application, including any supporting documentation, background information, and biometric data may be shared among Customs and Immigration authorities in both Mexico
and the U.S. and among law enforcement and other government agencies in accordance with applicable laws. I certify that I have read, understood, and agree to abide by all
conditions required for use of the FAST program, including all instructions and notices accompanying this application.
Applicant
Name (print) Signature Date
69.
Card holder's name (please print)
I am enclosing a certified check or money order payment
The fee for an applicant to the FAST program is $50.00 US only
All credit card fees will be processed as U.S. funds
Card holder's signature
Visa
MasterCard
Card no.
Expiration
Date
(yyyy/mm)
(yyyy/mm)
(yyyy/mm)
(yyyy/mm/dd)
(yyyy/mm)
Once an application has been processed, absolutely no refunds will be granted. No exceptions.
Discover American Express
If yes, have you ever received a waiver of inadmissibility to the U.S. from the CBP (former USINS)?
Have you ever been found in violation of customs or immigration laws?
No
Yes
CBP Form 823F (07/10)(Back)
(yyyy/mm)
SECTION C - EMPLOYMENT HISTORY FOR THE LAST 5 YEARS
SECTION D - ADDITIONAL INFORMATION
SECTION E - CERTIFICATION
SECTION F - FEE PAYMENT (non-refundable)
Please mail or take your completed application along with fee to the nearest U.S./Mexico FAST Enrollment Center. Locations and addresses of U.S./Mexico FAST Enrollment
Centers can be found at www.FASTDRIVER.gov
U.S. PRIVACY ACT STATEMENT
The authority to collect the information on this application, any supporting documentation, fingerprints, and other requested information is contained in Titles 8 and 19 of the U.S.
Code and corresponding regulations. Furnishing the information on this form is voluntary; however, failure to provide all the requested information may result in the delay of a final
decision or denial of your application. The information collected will be used to make a determination on your application. It may also be provided to other government agencies
(Federal, state, local, and/or foreign) as permitted under the Privacy Act of 1974, 5 U.S.C. § 552a (2002), and other applicable law. All applicants are subject to a check of criminal
information databases and other immigration and customs databases in order to determine eligibility for this program.
