SHP- 9 8 4 B 0 1 / 09
Missouri State Highway Patrol
Applicant Fingerprint Services of Missouri
This Document is your Applicant Fingerprint Form for State and National Criminal History
Background Checks.
Section One: Agency Information
Agency ORI: ____________________________________________ OCA Number: ___________________________________
Agency Name: ___________________________________________ Mailing Address _________________________________
City __________________________ State _____ Zip ___________ FBI TCN ____________________________________
(if resubmission of rejected fingerprint)
Section Two: Applicant Information
Applicant Last Name _____________________________________First Name_________________Middle Name__________
(Please Print Name) |
|
Social Security Number __________________________________Date of Birth ______________ Sex: |
Male |
Race: _____________________________ Height ___________ Weight _________ Hair Color ________ Eye Color ________
(White, Black, Asian, American Indian) (Feet/Inches)
Place of Birth _________________________________________ Citizenship _________________________________________
(State or Country)(Country)
DL / ID No. __________________________________________ State Issuing DL / ID No. ______________________________
Home Street Address ______________________________________________________________________________________
City _____________________________________ State ______________________________ Zip ________________________
Section Three: Service Center Information On-Line Registration
When utilizing MOAPS fingerprinting services through L-1 Enrollment Services, you must schedule a fingerprint appointment online by visiting www.L1id.com or by calling 1-866-522-7067. You may pay for fingerprint services with a credit card or onsite with a check or money order only. Your fingerprints will be submitted to the Missouri State Highway Patrol (MSHP) and the Federal Bureau of Investigation (FBI), if applicable, with results delivered to the authorized agency within 5 to 10 business days.
1.Logon to www.L1id.com and select Missouri.
2.Enter your name (first and last name).
3.Enter ____________________ when prompted for Agency Number or ORI.
4.Enter ____________________ when prompted for OCA Number.
5.Follow the prompts to enter your personal information and select service location, date and time.
6.Bring this completed form with you to your appointment.
Section Four: Service Center Information (To be Completed by Fingerprint Technician)
Date Prints Taken _____________________________ Amount Charged For Service _______________________________________________
Paid by (enter payment form): |
Check |
Money Order |
Visa |
MasterCard |
Billing Acct. _____________________________ |
Applicant TCN/OCN __________________________________________________________________________________________________
I have compared the government-issued identification presented by the applicant and attest that to my best determination, I have fingerprinted the same person.
Printed Name of Fingerprint Technician____________________________________________________________________________________
Signature of Fingerprint Technician________________________________________________________________________________________
APPLICANT – THIS FORM IS YOUR RECEIPT FOR SERVICES – RETAIN FOR YOUR RECORDS.