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DNA Testing
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Schedule Appointment
Contact Us
Home
Forms
About
Services
Live Scan Fingerprinting
DNA Testing
Drug Testing
Schedule Appointment
Contact Us
Home
Forms
About
Services
Live Scan Fingerprinting
DNA Testing
Drug Testing
Schedule Appointment
Contact Us
Department of Motor Vehicle DMV Live Scan Fingerprinting Occupational Licensing
Call for fee
Please read instructions on reverse before completing form.
A0059
ORI (Code assigned by DOJ)
APPLICANT COMPLETES (EXCEPT ITEM 15) — PLEASE PRINT.
CHECK APPROPRIATE BOX (SEE REVERSE FOR INSTRUCTIONS)
Department of Motor Vehicles Licensing Operations Division Occupational Licensing Branch P. O. Box 932342 MS—L224 Sacramento, CA 94232-3420
Five Digit Mail Code: 04620
Ambulance Driver Certificate Only
Department of Motor Vehicles Licensing Operations Division Issuance, Commercial Driver License P.O. Box 942890 Sacramento, CA 94232-3420
Five Digit Mail Code: 04621
Contact: Operations Manager 916-229-3153
Contact: CDL/PDPS Manager 916-657-5771
TYPE OF APPLICATION (ONLY IF CHECKING BOX “A” ABOVE) — Check One
License
Permit
Business Partner Automation Program Participant (BPA)
Employer Testing Program Examiner (ETP)
APPLICANT NAME (LAST, FIRST, MIDDLE INITIAL)
AKA (LAST, FIRST)
ADDITIONAL AKA (LAST, FIRST)
DATE OF BIRTH
SEX
Male
Female
HEIGHT
WEIGHT
EYE COLOR
HAIR COLOR
PLACE OF BIRTH
SOCIAL SECURITY NUMBER
CALIFORNIA DRIVER LICENSE/IDENTIFICATION NUMBER
NO BILLING NUMBER—APPLICANT PAYS
MISCELLANEOUS NUMBER
HOME ADDRESS AND TELEPHONE NUMBER
STREET
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
YOUR NUMBER (OCA NUMBER—AGENCY IDENTIFYING NUMBER) OLAD 1
IF RESUBMISSION, LIST ORIGINAL ATI NUMBER
LEVEL OF SERVICE
DOJ
FBI-BPA/ETP CHECK
LIVE SCAN OPERATOR COMPLETES
OPERATOR COMPLETING LIVE SCAN TRANSACTION
DATE
TRANSMITTING AGENCY (LSID NUMBER)
ATI NUMBER
AMOUNT COLLECTED
AMOUNT BILLED
SUBMIT
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