FDLE Live Scan Service Enrollment Form

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First Name

Middle

ABOVE Name: Enter

Last Name:

ORI

This will be supplied by your employer EXAMPLE: FL920150z

Pick one: AHCA Yes or No:

If AHCA please present employers “Livescan Request Form”

Enter AHCA Screening ID Number: ONLY IF YOU PRESSED YES ABOVE

Screening ID Number assures that the subject’s photo is married to the AHCA fingerprint results. If no Livescan Request Form request the applicant call the employer to obtain the Screening ID Number. The screening ID number can be left blank and added to the record after FDLE submission and resent to AHCA separately later. AHCA applicants Require a SSN: (Given verbally at time of fingerprinting) Finance Division and now many other ORI’s now also require a SSN. So it is a good practice to require a SSN for all records now. If a person does not have a SSN they are advised by FDLE to Apply for an Individual Tax Identifier Number: https://usa.taxgov.org/home/lp/for-non-residents/?gad=1&gclid=Cj0KCQjwiIOmBhDjARIsAP6YhSVu9KmU3gqXQQSqlWpGxvNGGVqB_NGW17SnJvhJhciuvGin-8ZRb8IaAtNUEALw_wcB

Phone #