Form HAZ-600 - Request for Fingerprinting Services - New York

Before completing this form, please read the instructions on page 2
REQUEST FOR NYS FINGERPRINTING
SERVICES - INFORMATION FORM
ORI
NYSHAZMAT
CONTRIBUTOR AGENCY
NYS Department of Motor Vehicles
JOB OR LICENSE TYPE
HazMat Driver
Last, First, Middle, Suffix
PAGE 1 OF 2
HAZ-600 (7/15)
Section 1: Carrier Information
Section 2: Applicant Information
License ID Number: Enter the 9-digit number from the NYS commercial driver license.
Name of Applicant: Enter the name exactly as it appears on the applicant’s NYS commercial driver license
Alias/Maiden Name: (If applicable)
Billing Account Number(If applicable)
You need this information
to schedule your appointment
to be fingerprinted:
Street # and Name
Country
Home Address:
City State Zip Code
Daytime Phone Number:
Area Code
( )
Date of Birth:
Daytime Phone Type
o Cell o Home o Work o Pager o Other
Gender:
o Male o Female
Height:
__________ Feet __________ Inches
Month Day Year
Race:
Skin Tone:
Place of Birth:
State
Country of Citizenship:
Alien Registration Number (If applicable)
Ethnicity:
Hair Color: Eye Color
o Hispanic o Non Hispanic o Unknown
Age
Weight:
_____________ lbs.
Important Information About FBI Record Checks: Your fingerprints will be used to check the criminal history records of the
FBI. You have the right to review the information on your FBI record. If you believe your record is incorrect or incomplete, you
can request that it be changed, corrected, or updated. For more information and instructions, visit the FBI web site at:
http://www.fbi.gov/about-us/cjis/criminal-history-summary-check
s.
reset/clear
Page 1/2
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Form HAZ-600 - Request for Fingerprinting Services - New York PDF

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