I Ball A0084 Form PDF Details

The I Ball A0084 form serves a precise purpose in streamlining the process for requesting Live Scan services, which are essential for background checks commonly required for licensing, certifications, or permits, notably for positions like Notary Public. Individuals aiming to submit their fingerprints for such checks must meticulously fill out this form, ensuring the inclusion of vital information like full name, aliases used, date of birth, gender, physical descriptors, place of birth, Social Security Number, driver’s license number, and other identifiers. The document clearly outlines the necessity of presenting identification before fingerprinting and preparing to cover both the fingerprint processing and the rolling fees, with a reminder to verify the acceptable payment methods and fee amounts with the chosen Live Scan site. Important components of the form also highlight the specifics regarding the type of application—like a license, certification, or permit—the pertinent agency information, including the billing number and the agency authorized to receive criminal history information. Moreover, the form emphasizes the importance of retaining a copy for one’s records, serving as proof of payment for the fingerprint processing. This aspect ensures that if a resubmission of prints is necessary, the applicant is not required to repay the processing fee, although a rolling fee may still apply. Additionally, for certain submissions that require further action, like those from employers specified by statute, additional information regarding the employer must also be included. Overall, the efficient and accurate completion of the I Ball A0084 form is crucial for ensuring the smooth processing of necessary background checks for various official applications.

QuestionAnswer
Form NameI Ball A0084 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesbcii scan applicant form, ca sos bcii 8016, sos sosbcii fill, ca bcii 8016 applicant form

Form Preview Example

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.

REQUEST FOR LIVE SCAN SERVICE

Applicant Submission

ORI:

 

A0084

 

 

 

Type of Application:

 

 

 

 

LICENSE CERT OR PERMIT

 

 

 

 

 

 

 

Code assigned by DOJ

 

 

 

 

 

 

 

 

 

 

 

 

 

Job Title or Type of License, Certification or Permit:

 

 

 

 

NOTARY PUBLIC 8201.1 GC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Address Set Contributing Agency:

 

 

 

 

 

 

 

 

 

 

 

 

 

CASGSECRETARY OF STATE

 

 

 

 

 

 

03690

 

Agency authorized to receive criminal history information

 

 

 

 

 

 

Mail Code (five digit code assigned by DOJ)

 

 

 

1500 11TH STREET 2ND FLOOR

 

 

 

 

 

 

 

 

 

 

 

Street No.

 

 

 

 

 

 

 

 

Street or P.O. Box

 

 

 

 

 

 

Contact Name (Mandatory for all school submissions)

 

 

 

SACRAMENTO

 

 

 

 

 

CA

95814

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

State

Zip Code

 

 

 

 

 

 

Contact Telephone No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Applicant:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(please print)

 

Last

 

 

 

First

 

 

 

MI

 

Alias:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver’s License No.

 

 

 

 

 

 

 

Last

 

 

 

 

 

First

 

 

 

 

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

 

SEX: Male

Female

Misc. No. BIL - APPLICANT MUST PAY AT LIVE SCAN SITE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Billing Number

 

Height:

 

 

 

 

Weight:

 

 

 

Misc. No:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Eye Color:

 

 

Hair Color:

 

 

 

Home Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street or P.O. Box

 

Place of Birth:

City, State and Zip Code

SOC:

Your Number:

 

Level of Service

OCA No.

X

DOJ

XFBI

If resubmission, list Original ATI No.

Employer: (Additional response for agencies specified by statute)

 

Employer Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street No.

Street or P.O. Box

 

 

 

Mail Code (five digit code assigned by DOJ)

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

State

 

Zip Code

 

 

 

Agency Telephone No. (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Live Scan Transaction Completed By:

 

 

 

 

Date:

 

 

 

 

 

 

 

 

Name of Operator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transmitting Agency

 

 

 

ATI No.

 

 

 

 

 

 

Amount Collected/Billed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOS/BCII 8016 (orig. 4/01; rev. 9/16)

ORIGINAL-Live Scan Operator

SECOND COPY-Applicant THIRD COPY (if needed)-Requesting Agency

 

 

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1. To start with, once filling out the bcii 8016 life applicant fillable, begin with the section with the next fields:

Completing segment 1 of california bcii 8016

2. Once your current task is complete, take the next step – fill out all of these fields - Employer Name, Street No, Street or PO Box, Mail Code five digit code assigned, City, State, Zip Code, Agency Telephone No optional, Live Scan Transaction Completed By, Date, Name of Operator, Transmitting Agency, ATI No, Amount CollectedBilled, and SOSBCII orig rev ORIGINALLive with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Part number 2 in filling in california bcii 8016

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