New .Jersey Universal Fingerprint Form www.bioapplicant.com/nl

(7) Contnbutor's Case # (Unique Idenl ifier)

EMPLOYER

(9) First Name

(12) Daytime Phone Num ber

( ) ­

( ' 7) Malden or Alias Las! Name

(20) Home Address

Address

(21) Gender (Select one)

I

I.'§: 1

(25) Occupa uon / Posrtion (w ith respect to ReqUIrement)

(2) Category (3) Statute Num ber

PER 13:59-1 (5) Document Type I (6) Payment tntorroa trou

S1 $40.00 (6) Miscellaneous

I (11) Last Name

I (15) Heigh t I(16) Welghl

I I (19) Country of Curzen stup

Slate l ip

'~ Race (Select 0 0" If P 1C I I I . h " J , h I

\I • ., . A ,"l" t . , I· I , I I. ,, ~ ,. .. t \ "' 11 J I

I Jr- • - •

esources Department

Z,p 07728 Identification ReqUirement - utenut.ceuo» must be presented at the time of grmMq Ide nhticahon presen ted M US T be one (1) document Ihalls current (not exp rrec ) A combmauon of docum ents w rll not be accep ted. Th e smgle document must Include the follo wing crileri a: Photo, Name . Addre ss (nomerernptoyer). Da te of Bil1h and IS Issued by a Feder al. State , Co unty or Municlpai enhty for identifica tio n purp oses. Exam ples of accept able ID are : 1) Va lid U S Stale Phot o Oliver's Lice nse/ Non Oli ver's Lice nse. 2) U.S. Pas sport , 3) USCI S Per manent Residen t ID Card (Issued after 5/ 10/2010) , and 4) USCIS Employ ment Authorizauon Car d (Iss ued afte r 10/3 1/2 010)

i 1) Orrglnallng Agency Number (ORI # )

NJPRROOOO (4) Reason for Flngerpllnling

PERSONAL EMPLOYER REQUEST

(10)MI

(13) Social Secuntv Number (O pnonat ) I (14) Date of Birth

(18) Place of Birth (US Slate II US Citizen' Country for all others)

Cily

(22) Hair Color (23) Eye COlor

(26) Employer / Organization Name (wltl1 re spect 10 ReqUiremen~

County of Monmouth Human Employer Address 1 EM ' S

ast am treet City Freehold Stale NJ

Please READ this form carefu lly and tottow all ot the vis trucnon s provrded by your agency/emp loyer to comptete tne fingerprin t pro cess Yo u must have this torm (Blocks 1 through 26) compteted pnor /0 sc nedutuu; your Imgerpnnt eppomtment via the web site or call center. PLEASE PRINT LEG/SL Y, II rs required you p resent thiS completed Universal Fingerpnnt Form , IOG_NJAPP_110113, at your scheduled eppotntmen t

Appoin tment Schedul ing : SCheduling IS av ailable any time at www 1)19 (Ju lie lit QIIIIII I. Appo intments may also be sched uled tnrouqn ou r Ca ll Ce nte r English and Sparusn spe aking age nts are available at 1·87 7-50 3-5981 , Monday throu gh Friday, 8:00AM to 5.00PM EST and Sa turda y. 8 OOAM to 12 N oon ES T

Pjlyment : Wh en an Applican t is responsib le for payment. Pay ment Is ReqUi red at the time of scheduling The follOWing forms of payment are accept ed Visa. MasterCard , or erectroruc debu (AC H) Irom a chec king account: ac counts will be oebu ec Immediately Money Order IS rne onl y form of payment acce pted at the enrollmen t cen te r

Cancell Reschedule : • App ointme nts ma y be canceled or resched uled via the website or the ca ll ce nter be /ore the deadline of 5PM EST the busmess day pnoi to the sche duled appo intmen t (Saturday Noon for Monday appointmen ts) An appointment fee o f $10.00 will be incurred by appli cants wh o do not cancel/r eschedu le their appo intment prror to the de adline ' Morp hoTrus t will refu nd the rem ainder of the fee paid (stale/federal search fees) to the angin al payment method

Unable to be Fingerprinted. An appli cant IS considered "Un able to be Fingerpri nted " for any of the fo llow ing reasons . Fa ilure to ap pea r for scheduled appointment, Inabili ty to prese nt proper ldenuficatlon: Ina blilly to prese nt trus comple ted Unive rsal Fingerprint Form IDG_NJAPP_1 101 13. Inform al ion on this form does not exactly match the mrorrnatrc n provided dunnq the schedllhng process Apptican ts unable \0 be finge rprrnted will Incur a $10.00 app om trne nt fee Mor pho Irust Will relund the remainde r 01 the tee paid (s tate /tederat search lees) 10 the origi nal pa yment method

peN and Rec eipts : Upon the comp let ion of fingerprinting you wil l be ass igned a PCN number. The PC N will be recorded on this form and on your receipt MorphoTrust Will '101 provide duptrcate receipts. p eN Numbers or any appomtmenllp rtntlng mtormetion a lter the time 01pnn ltng

Apphcant 10 Payment IpeN Number. A utnonzanon

Scl1eduled Scneduled ISCheduled Day & Date' Time Site'

Agency Information

I You MUST reta in a copy of this form and the receipt of print ing for you r personal records .

APPLICANTS MUST NOT ALTER, SHARE, OR REUSE THIS FORM IDG NJAP P_ ' 10113

FORM D

PLEASE READ THE FRONT AND BACK OF THIS FORM CAREFULLY:

Applicants tha t require the following fingerprint based background checks and need the results ma iled back to the employer's address must use form " 0" :

Employment (** responses returned to emp loye r* *)

I f none of the above reasons meet your needs, please inqu ire about additional forms (see below) that may be used for (Illge rprint based New Jersey Criminal History Background Checks.

Form A: Good Conduct Immigration Naturalizatio n Personal Record Visa EXfJungement

Form B. International Adoption Requ iring notarization Foreign business requmnq notarizat ion

Form C: Employment (" responses returned to appl icant )

By unhz.nq form "D", you are requesting and authonzinq the New Jersey State Police to conduct a fingerprint based New Jersey Criminal History Background Check.

The New Jersey State Police uses the live scan fingerprinting services provided by Morpho Trust USA, a priv ate company under contract wrth the State of New Jersey. In orde r to be fingerprinted for one of the purposes listed above, you arc required to contact Morpho Trust to schedule a time and place to have your fingerp rints recorded . Tile quicxes t and easiest way to schedule your appointmen t IS Via the Web at www.bioapplicant.com/nj . Web scheduling IS available 24 hours per day, seven days per week . Applicants who do not have Web access should call f"lorpllo Trust at the company 's toll -free telephone number, 1-877-503-5981 (Mon day th rough Friday, 8 :00 a.m. to 5:00 p.m., and Saturday, 8:00 a.m. to 12:00 noon) . Spanish-speaking operators are available upon request.

You must brmg this form with you to your scheduled fingerprin t appointm ent. In addition to this form, you must bring proper identification as outl ined on the front of the Universal Fingerprint Form , The home address that you fill out on the attached form should be the same as the home address printed on the identificat ion that you provid e to Mor pno Trust USA YOUR ADDRESS MUST BE COMPLETE AND ACCURATE IN ORDER TO PROPERLY MAIL BACK THE RESULTS OF YOUR CRIMINAL HISTORY BACKGROUND CHECK. To ensure accuracy, please legibly complete blocks #9 thru #26 on the fron t of this form prior to schedul ing your appo intme nt .

The fee for this service IS $40.00. Accepted forms of payment are money order, credi t card and etectrornc debit check. AI the tune of scheduling your appointment, payment will be required and cllarged to your account. Appointments must be canceled by noon on the business day prior to your scheduled time (you must cancel by Saturday at noon for a Monday appointment). [( you (ail to cancel your scheduled appomtrnent, you Will torfeit the $10.00 port ion of you r fingerpr int fee that IS payable to Morpho Trust. You will also forfcrt the $10.00 fce if you fall to bring the Universal Frngerpr int form and proper ID when having your fingerprints scanned.

Failure to ut ilize th is form for its intended purpose and/or failing to provide complete and accurate information may result in haVing to be fingerprinted again and incurring additional costs.

Any questions regardi ng the use of thrs form can be directed to your Local or State Police Departmen t where you obtamec this form, or contact the New Jerscy State Police, Criminal Information Unit at 609 882-2000 ext. 29 18. Addit ional mforrnation on cruruna: history backgro und checks may also be found on our website at www .njso .orq .