STATE OF MARYLAND
DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES
CRIMINAL JUSTICE INFORMATION SYSTEMS – CENTRAL REPOSITORY

LIVESCAN PRE-REGISTRATION APPLICATION

APPLICANT INFORMATION (PLEASE TYPE OR PRINT CLEARLY)
Male
Female
ft. inches
lbs.
Black or African American
White
Hispanic or Latino
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Two or more races
Other
AGENCY INFORMATION
  • Adult Dependent Care
    Attorney/Client
    Minor Care
    Criminal Justice
    Gold Seal/Adoption
    Gold Seal/Letter/VISA
    Government Employment
    Government Licensing or Certification
  • Immigration/VISA
    Individual Challenge
    Individual Review
    MSP Licensing
    Private Party Petition
    Public Housing
REQUIRED INFORMATION
Mail Response To
(Mailing option only available for Visa Gold Seal and/or Individual Review)