Bcii 8016, Request For Live Scan Service
STATE OF CALIFORNIA
DEPARTMENT OF JUSTICE
BCII 8016
(orig. 4/01; rev. 6/09)
REQUEST FOR LIVE SCAN SERVICE
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Reset Form
Applicant Submission
ORI (Code assigned by DOJ)
Authorized Applicant Type
Type of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)
Contributing Agency Information:
Agency Authorized to Receive Criminal Record Information
Mail Code (five-digit code assigned by DOJ)
Street Address or P.O. Box
Contact Name (mandatory for all school submissions)
City
State ZIP Code
Contact Telephone Number
Applicant Information:
Last Name
First Name
Middle Initial
Suffix
Other Name
(AKA or Alias) Last
First
Suffix
Date of Birth
Sex
Male
Female
Driver's License Number
Billing
Height
Weight
Eye Color
Hair Color
Number
(Agency Billing Number)
Misc.
Place of Birth (State or Country)
Social Security Number
Number
(Other Identification Number)
Home
Address Street Address or P.O. Box
City
State
ZIP Code
Your Number:
Level of Service:
DOJ
FBI
OCA Number (Agency Identifying Number)
If re-submission, list original ATI number:
Original ATI Number
(Must provide proof of rejection)
Employer (Additional response for agencies specified by statute):
Employer Name
Mail Code (five digit code assigned by DOJ
Street Address or P.O. Box
City
State
ZIP Code
Telephone Number (optional)
Live Scan Transaction Completed By:
Name of Operator
Date
Transmitting Agency
LSID
ATI Number
Amount Collected/Billed
ORIGINAL - Live Scan Operator
SECOND COPY - Applicant
THIRD COPY (if needed) - Requesting Agency
