New York Request form for Fingerprinting Services — OUT of STATE RESIDENTS (rev01252018) is a document used by individuals who reside out of state and need to complete a criminal background check for employment, licensing, certification or other legal purposes. This form must be completed and signed by the applicant and returned to the requesting agency along with the required fee, two sets of rolled fingerprints, and other required documents. It consists of two main sections: the Applicant Information section and the Agency Information section. The Applicant Information section of the form requires the individual to provide their name, current address, date of birth, Social Security Number, and other contact information. The Agency Information section requires the individual to provide the name and address of the requesting agency, the purpose of the request, and the type of search being requested. The New York Request form for Fingerprinting Services — OUT of STATE RESIDENTS (rev01252018) is typically used in conjunction with two other forms, the FD-258 Fingerprint Card and the Release Authorization form. The FD-258 Fingerprint Card is used to take the applicant’s fingerprints and the Release Authorization form is used to authorize the release of the applicant’s criminal history records. The New York Request form must be submitted along with the other two forms and the required fee in order to complete the criminal background check.