Dmv 8016 Form – Fill Out and Use This PDF

(License, Certification, Permit Only, or Business Partner Automation Program Participant)

To verify your identity, please bring an official governmental photo document (e.g., driver license, identification card, passport, etc.) with you to the live scan site. Processing fees are non-refundable.

APPLICANT COMPLETES (EXCEPT ITEM 15) — PLEASE PRINT.

3.TYPE OF APPLICATION (ONLY IF CHECKING BOX “A” ABOVE) — Check One

4.APPLICANT NAME (LAST, FIRST, MIDDLE INITIAL)

5.AKA (LAST, FIRST)

ADDITIONAL AKA (LAST, FIRST)

LIVE SCAN OPERATOR COMPLETES

DISTRIBUTION: ORIGINAL - Live Scan Operator

SECOND COPY - Requesting Agency

THIRD COPY - Applicant

DMV 8016 (REV. 1/2019) WWW

INSTRUCTIONS FOR COMPLETING FRONT

1.Code Assigned by DOJ: ORI number pre-printed.

2.Agency Address Set Contributing Agency:  Check box “B” if applying for an Ambulance Driver Certificate. Check box “A” for all other licenses, Vehicle Verifier Permit, or Business Partner Automation Program Participant. 

3.Type of Application: Check one. Applications for the following type licenses require Live Scan services.

4.Name of Applicant: Enter applicant’s full name.

5.AKA: Enter any other names applicant has used.

6.Date of Birth: Enter applicant’s date of birth.

7.Sex: Check the appropriate box for gender: Male, Female, or Nonbinary.

8.Height: Enter applicant’s height.

9.Weight: Enter applicant’s weight.

10.Eye color: Enter applicant’s eye color.

11.Hair color: Enter applicant’s hair color.

12.Place of birth: Enter city, state, and country

13.Social Security Number: Enter applicant’s social security number.

14.California Driver License/Identification Card number:  Enter applicant’s California Driver License/Identification Card number.

15.Applicant Pays: Live Scan operator will complete.

16.Miscellaneous Number: Enter other identifying numbers (e.g., other state driver license number).

17.Home Address: Enter applicant’s residence address and telephone number.

18.Your number: DMV identifying number pre-printed.

19.If resubmission:  Enter  the  original ATI  number  provided  on  the  reject  notification  to  avoid  paying  an  additional processing fee.

20.Level of Service: DOJ required for occupational licenses, in addition, FBI required for Business Partner Automation Program Participants, and employer testing program examiners.

21.Operator Completing Live Scan Transaction: Enter operator’s name.

22.Date: Enter date transaction was completed.

23.Transmitting Agency:  Enter live scan identification number.

24.ATI Number: Enter ATI number.

DMV 8016 (REV. 1/2019) WWW