Fingerprint Form

Fingerprint Registration Form

Please complete all fields below
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Phone Number*
Gender*
Race*
Height*
Weight*
Eye Color*
Hair Color*
Social Secuirty Number*
Place of Birth*
Citizenship Country*
Your photograph will be taken during the fingerprinting process. Please dress appropriately. You must have a valid photo ID in order to be fingerprinted. You will be given a coupon code to use in lieu of payment.

By signing this authorization, I hereby acknowledge that I consent to the collection and retention of my fingerprints as part of the application/employment/licensing process.

I acknowledge and understand that my fingerprints will be searched against the fingerprint databases maintained by the Federal Bureau of Investigation and the Tennessee Bureau of Investigation for the purpose of assessing and reviewing state and national criminal history that may pertain to me directly, pursuant to 28 CFR, Sections 16.30-16.34.

I acknowledge that I have been notified of the procedures to challenge the accuracy or completeness of my record, set forth in Title 28 CFR 16.34. I am aware that a copy of these procedures may be downloaded from FBI.gov.
I AGREE and affirm that I have read and fully understand the above and consent to this background check and to the results being released to the Qualified Entity with which I am or am seeking to be employed or to serve as a volunteer. By checking this box, I understand I am electronically signing this document and indicating my agreement with the terms and conditions of the background investigation.
Please verify that you are human*
Signature*

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Fingerprint Registration Form