INSTRUCTIONS FOR COMPLETING REQUEST FOR LIVE SCAN SERVICE
APPLICANT SUBMISSION FORM
Be sure to take identification to the live scan site. You must show ID prior to having your
fingerprints taken.
The following information must be printed or typed on the form. All other spaces on the form
should remain blank.
Name of Applicant: Enter your full name.
Alias: Enter any other names you have used.
Date of Birth: You must provide your date of birth in order for the Secretary of State’s Office
to process your background check.
Sex: Gender (male or female)
Height
Weight
Eye Color
Hair Color
Place of Birth
SOC: Social Security Number.
Driver’s License No.: California driver’s license number. If you do not have a California
driver’s license, enter other identifying numbers such as another state driver’s license number
or California ID card number.
Agency Billing No.: Please be prepared to pay the fingerprint processing fee and the rolling
fee at the live scan site (cash, check or money order). Be sure to call the live scan site to
determine the acceptable type of payment and the amount of the required fee.
Agency/OCA No.: Enter your driver’s license number or birth date.
IMPORTANT: Retain one copy of the Request for Live Scan Service form for your records
in case you need to have your prints retaken. This copy will serve as your proof that you have
paid the fingerprint processing fee so you will not be required to pay again. You may,
however, be required to pay for the rolling fee.
