Fingerprinting Services Request

Please complete the following form and submit it to us prior to arriving for your fingerprinting appointment.

If you have not submitted this form we cannot take your fingerprints.

We thank you for your understanding.

Name*
First Last
I require fingerprinting services for the following:*
UCI / Application #
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I require the results of my fingerprint certification (Police Check) to be sent to the following location:
- My Home Address (listed above)
- Other Address (listed below)
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
This is the address you would like your fingerprinting certification document to be sent to. Example: CIC Office, employer, etc
Phone Number*
Email
Date of Birth (yyyy/mm/dd)*
Government Identification #1
Max. file size: 2 MB.
Government Identification #2
Max. file size: 2 MB.