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  • Cjis 9004, Request For Exemption From Mandatory Electronic Fingerprint Submission Requirement

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STATE OF CALIFORNIA CJIS 9004 (Rev. 01/2013)DEPARTMENT OF JUSTICEREQUEST FOR EXEMPTION FROM MANDATORY ELECTRONIC FINGERPRINT SUBMISSION REQUIREMENTBureau of Criminal Identification and Analysis P.O.

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Contrary to popular belief, it does not need to be filled out by a law enforcement agency. In fact, nearly all FD-258 cards submitted with NFA purchases are done by the user themselves! We will give you some helpful instructions so you can successfully complete your FD-258 Fingerprint Card.

Title 16, California Code of Regulations, Sections 1419, 1419.1, and 1419.3 require the submission of fingerprints when a nurse renews his or her California nursing license if the licensee was not previously fingerprinted by the Board or if a record of fingerprint submission no longer exists.

GUIDE FOR COMPLETING YOUR FD-258 CARD. **Do not write on the card until you check with your fingerprinting location. ... 1 Name. Last, First, Middle. 2 Aliases Enter all former names/aliases. ... 3 ORI number. ... 4 Date of Birth. ... 6 Demographic information. ... 7 Place of Birth. ... 8 Social Security Number.

Contact Us Application status updates can be found by visiting our Application Status and Details page, by emailing BRN.Licensing@dca.ca.gov or by calling the BRN main line at (916) 322-3350. Please review the BRN's application timeframes for initial review prior to reaching out to BRN staff.

AKA-ALIASES – All other names used in the past including maiden names and previous legal names (no nicknames).

Please do not fold the fingerprint card. Please use a 9” X 12” envelope to return your completed fingerprint card with fee. Write “DO NOT FOLD” on the envelope. If your card is folded, you may be required to complete and submit a new fingerprint card.

All of the above items should be mailed directly to the Board by the individual(s) or agency who is providing information about the applicant. Have these items sent to the Board of Registered Nursing, Licensing Unit, P.O. Box 944210, Sacramento, CA 94244-2100.

Fingerprint Requirement for License Renewal Type of Results and Timeframes: FAX Live Scan form to: ATTN: Fingerprint Unit. (916) 574-8647. MAIL Live Scan form to: Board of Registered Nursing. ATTN: Fingerprint Unit. 1747 N. ... MAIL FD-258 Fingerprint Card with $49 payment to: Board of Registered Nursing. ATTN: Fingerprint Unit.

0:27 3:24 How To Fill Out an FD-258 Fingerprint Card - YouTube YouTube Start of suggested clip End of suggested clip Color the blocks marked with x should be left. Out. Here are the areas that need to be filled. FillMoreColor the blocks marked with x should be left. Out. Here are the areas that need to be filled. Fill out the signature of the subject in block. One followed by the residential. Address in block.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232