Careers

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Careers
Contact Us

Home
About Us
Services
Careers
Contact Us

Our care is your independence.

Listed below are some of the types of care services we provide for our seniors and/or disabled population.

State of Maryland
Department of Public Safety and Correctional Services
Information Technology and communications Division
Criminal Justice Information System – Central Repository (CJIS-CR)

LIVESCAN PRE-REGISTRATION APPLICATION

APPLICANT INFORMATION

Please type or print legibly.

Name

Date of Birth:

Social Security Number:

Gender: MaleFemale

Height:

Weight:

Eye Color:

Hair Color:

Race/Ethnicity:
BlackWhiteAsian/Pacific IslanderNative AmericanOther

Place of Birth:

Citizenship:

City: Windsor Mills

State:

Zip Code:

Phone Number:

Driver’s License Number:

Email Address:

REASON FOR REQUEST

INDIVIDUAL

Please select one of the following:
Gold Seal/AdoptionGold Seal/Letter/VISAImmigration/VISAIndividual ChallengeIndividual ReviewAttorney/Client

Mailing Information:

Name:

Street Address:

City:

State:

Zip Code:

AGENCY

Please select from the following (*ORI Required):
Adult Dependent CareChild Care*Criminal Justice*Government Employment*Government Licensing or Certification*Maryland State Police Licensing*Private Party Petition**Public Housing

Agency Authorization Number:

*ORI Number:

**Position Applied: