Overview of the Criminal
Background Check Process
Dear License Applicant:
This Criminal Background Check Packet has been sent to you because you have applied for initial license, license renewal
or you are the subject of a Board investigation with one of the Minnesota Health Licensing Boards. Minnesota law and
Board policy now require that all applicants must complete a fingerprint-based criminal background check. See Minn.
Stat. § 214.075.
The Minnesota Health Licensing Boards have cooperatively established a Criminal Background Check Program (CBCP)
to help you efficiently complete this requirement. Included in this packet are “Instructions For Getting Fingerprints
Taken” and a Mailing Checklist. Please direct any questions you have about the background check process to Criminal
Background Check Program staff, not the Boards.
To complete the background check, you must do the following:
1. Submit your application and pay all fees to the Board. The background check fee is included in this payment.
2. Complete Forms 1–3. (attached) ***Note: You must sign Form 3 in the presence of the person taking your
fingerprints at the time your prints are taken; person taking your prints must then complete the bottom
portion of Form 3.***
3. Have high quality fingerprints taken by one of the following:
• The Minnesota Criminal Background Check Program (CBCP)
• Law Enforcement Agency
• Other qualified vendor
4. If prints are taken at a law enforcement agency or vendor location, you must mail a hard copy fingerprint card
(FD-258) and Forms 1–3 to the CBCP office at the address below.
5. If prints are taken at the CBCP, Forms 1–3 will be collected during fingerprinting. A hard copy fingerprint card is
not needed when prints are taken at the CBCP office.
Your submissions will be forwarded to the Minnesota Bureau of Criminal Apprehension (BCA) and the Federal Bureau of
Investigation (FBI). They will be checked for criminal conviction records and Predatory Offender Registration data. The
results will be sent to the Board to evaluate your qualifications for licensure. The Board will contact you if additional
information is needed.
Important: High Quality Fingerprints Required
The background check requires a set of high quality fingerprints. Poor quality prints will be rejected by the FBI, which
requires you to submit a second set of fingerprints along with Form 3. To avoid potential weeks of delay, please see
“Important Tips to Improve Fingerprint Quality” (attached).
Prior Background Checks Cannot Be Used Again
The Board is unable to use any previous background check you may have undergone for work, military, other licensing,
or any other purpose. Federal law prohibits sharing fingerprint and criminal history information. You need to be
fingerprinted again for the license you are currently seeking and the result from this CBC may not be used for any other
purpose.
Please email or call if you have any questions about the criminal background check process, or if you would like to
schedule an appointment for fingerprinting at our office in Minneapolis, MN. Most appointments take 10–15 minutes.
Criminal Background Check Program
2829 University Avenue SE, Suite 555
Minneapolis, MN 55414-4202
criminal.background.check@state.mn.us
(651) 201-2822
Vers. 3.2 (electronic), last updated on 2/15/2019
Instructions for Getting Fingerprints Taken
You must have your fingerprints taken by one of the following:
1. Staff at the Criminal Background Check Program office in Minnesota; or
2. Law enforcement agency; or
3. Other qualified vendor
IDENTITY VERIFICATION
The person taking your fingerprints must confirm your identity with a valid, government-issued photo ID card. Examples
of acceptable photo ID include a driver’s license, passport, military ID, or other government-issued photo ID. When your
prints are taken, both you and the person taking your fingerprints sign Form 3: Identity Verification. At that time both
of you also sign the Fingerprint Card.
PRINTS NOT TAKEN BY CBC PROGRAM STAFF REQUIRE A HARD COPY FINGERPRINT CARD
Ask the fingerprinting agency to print a hard copy card for you to mail to the Criminal Background Check Program.
Only an “FD-258” (“Applicant”) fingerprint card that displays the Privacy Act Statement on the back will be accepted.
Most agencies will have cards available, however some locations may require you to bring your own fingerprint card. If
you need a hard copy card mailed to you, please contact the MN Criminal Background Check Program at
criminal.background.check@state.mn.us or (651) 201-2822.
USE THE CORRECT “ORI” NUMBER FOR YOUR BOARD
Fingerprint cards must include the Originating Agency (ORI) Number for your Board. The MN Board ORI numbers are
listed on the next page of this packet. If the law enforcement agency can only print their own ORI number, then write in
the appropriate MN Board ORI number in the space on the hard copy fingerprint card they give you. For more
information, see the attached document, “When & How To Fill Out Fingerprint Card.”
WHERE CAN FINGERPRINTS BE TAKEN?
1. Criminal Background Check Program in Minnesota
Criminal Background Check Program Hours: 8:30 am–12:00 pm, Method: LiveScan
2829 University Ave SE, Suite 555 1:00 pm–4:00 pm, M–F Cost: no additional charge for
Minneapolis, MN 55414-4202 BY APPOINTMENT ONLY! fingerprinting HLB applicants
651-201-2822 criminal.background.check@state.mn.us
2. Bureau of Criminal Apprehension (BCA) in Minnesota
1430 Maryland Ave E Hours: 8:00 am–4:00 pm, M–F Method: LiveScan
St. Paul, MN 55106 https://dps.mn.gov/divisions/bca/Pages/ Cost: $10 per fingerprint card
(651) 793-7000 Fingerprinting.aspx Payment: cash, check, money order
3. Local Law Enforcement in any State or Foreign Country
Contact local law enforcement agencies in your area to determine the following: (1) if they offer fingerprinting; (2) what
days/times fingerprinting is available; (3) if they want you or their own staff to fill out the fingerprint card; and (4) if there
is a fee. Local agencies may charge a fingerprinting fee that is separate from the fee you pay to the Board. Not all police
agencies take fingerprints, or their hours may be limited. Call first to check their policies and set up an appointment.
Examples of local law enforcement agencies to contact include the following: county sheriffs, your state’s crime bureau,
city police, tribal police, state patrol, licensed campus police, military police, and any other government law enforcement
agency. Even if your local police agencies do not do fingerprinting, they can often recommend
4. Other qualified vendors
WHAT TO BRING TO FINGERPRINTING APPOINTMENT?
____ 1. Forms 1–3 (enclosed). ***Reminder: BOTH you and fingerprint technician must sign Form 3.
____ 2. Valid government-issued photo ID.
____ 3. An acceptable payment method for any fee the agency charges for fingerprints.
____ 4. Depending on the agency you use, you may need to supply a Fingerprint Card. If required to bring your
own hard copy card, contact the Criminal Background Check Program at criminal.background.check@state.mn.us
or 651-201-2822.
Vers. 3.2 (electronic), last updated on 2/15/2019
When & How to Fill Out Fingerprint Card
DO NOT START FILLING OUT THE FINGERPRINT CARD YET!
• You do NOT need a fingerprint card if prints are taken at the MN Criminal Background Check Office.
• Prints taken anywhere else must produce a hard copy Fingerprint Card (use form FD-258) that you will mail to us.
• Some police agencies or vendors want their staff to fill out the card as part of the fingerprinting process.
• BEFORE filling out the fingerprint card, check with the police agency or vendor.
• Card must include Originating Agency Identification (ORI) for your Health Licensing Board. (see numbers below)
• If necessary, you may cross out incorrect ORI numbers and write in the correct MN Board ORI number on the card.
• Required fields are listed below, and on the enclosed “Sample Fingerprint Card.” Type or print legibly, in black ink.
• Stay within the field blocks. Do not overlap the blue lines. DO NOT FOLD OR STAPLE FINGERPRINT CARD.
Field Name Description / Format Instructions
Last Name followed by a comma (,) then First and Middle Name (if any).
1 Name
Suffix denoting seniority (Jr., Sr., III, etc.) should follow the middle or first name.
DO NOT SIGN UNTIL the time of fingerprinting.
2 Signature Of Person Fingerprinted
The person taking your fingerprints must personally witness your signature on the card.
3 Residence of Person Fingerprinted Enter residence address, not mailing address (unless they are the same).
4 Date The date you were fingerprinted, using six digits. (June 08, 2001 = 06/08/01)
5 Signature of Official Taking Prints Law Enforcement Agency or vendor employee signs here.
6 Reason Fingerprinted POR 214 075
7 Aliases/AKA Write any alias names used, including maiden name, prior name or any other legal name.
8 Citizenship Write "US" if citizen of United States, otherwise write out name of country of citizenship.
9 Social Security No. Write Social Security Number, if you have one.
10 Date of Birth Your date of birth, using six digits. (June 14, 2004 = 06/14/04)
11 Place of Birth Enter two-letter postal abbreviation for birth State, or spell out name of a foreign country.
12 Sex F = Female; M = Male
Use the abbreviations listed below for the physical description items in fingerprint card fields 13 - 17:
13 Race A = Asian / Pacific Islander I = American Indian / Alaskan Indian U = Unknown
B = Black W = White or Hispanic
14 Height (HGT) Express in feet and inches. Do not use fractions of an inch; round off to the nearest inch.
E.g.: four feet, eight inches = “408”; six feet, two inches = “602”; DO NOT USE METRIC
15 Weight (WGT) Express in pounds. Do not use fractions of a pound; round off to the nearest pound.
E.g.: one-hundred twenty pounds = “120”; DO NOT USE METRIC
16 Eye Color BLK = Black BRO = Brown GRN = Green MAR = Maroon PNK = Pink
BLU = Blue GRY = Gray HAZ = Hazel MUL = Multicolored XXX = Unknown
17 Hair Color BLK = Black BRO = Brown GRY = Gray SDY = Sandy BLU = Blue
PNK = Pink PLE = Purple WHI = White RED = Red or auburn ONG = Orange
BLN = Blond or strawberry BAL = Bald XXX = Unknown
Board ORI Board ORI Board ORI
Behavioral Health & Therapy MN920157Z Nursing MN920147Z Physical Therapy MN920146Z
Medical Practice MN920158Z Nursing Home Admin. MN920153Z Podiatric Medicine MN920155Z
Chiropractic MN920150Z Optometry MN920154Z Psychology MN920145Z
Dentistry MN920143Z Occupational Therapy MN920162Z Social Work MN920159Z
Dietetics & Nutrition MN920151Z Pharmacy MN920160Z Veterinary Medicine MN920149Z
Marriage & Family Therapy MN920152Z
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Vers. 3.2 (electronic), last updated on 2/15/2019
PLEASE NOTE: The back of the FD258 card must include the full Privacy Act Statement on the back of the card (as
shown below)
Vers. 3.2 (electronic), last updated on 2/15/2019
Mailing Checklist
DO NOT send in a fingerprint card or come in for a fingerprinting appointment until you
have FIRST paid all application fees and submitted your application to the Board.
____ 1. FORM 1 — Informed Consent: Criminal Background Check for Licensure
a. All information filled out?
b. Signed and dated by you?
____ 2. FORM 2 — Informed Consent: Release of Predatory Offender Registration Data
a. All information filled out?
b. Signed and dated by you?
____ 3. FORM 3 — Identity Verification Form
a. All information filled out?
b. Law Enforcement Agency or vendor employee personally reviewed your valid government-
issued photo ID at time of fingerprinting?
c. Signed and dated by you, while being observed by person who took your fingerprints?
d. Signed by the person who took your fingerprints?
____ 4. Hard Copy Fingerprint Card
a. You must submit a hard copy FD258 fingerprint card, unless you have your fingerprints taken
at the MN Criminal Background Check Program.
b. Do not fold or staple fingerprint card.
c. All required fields completed per instructions?
d. Correct ORI Number for MN Board printed (or handwritten) on card?
e. Date of fingerprinting
f. Signed by you, while being observed by person who took your fingerprints?
g. Signed by the person who took your fingerprints?
____ 5. Return Address
a. Write your applicable MN Board name in parentheses below your return address on the
envelope you use to send us your materials. This speeds mail sorting and saves time in
processing your background check.
YOURNAME
YOURSTREET
YOURCITY, YOURSTATE YOURZIP
(MN Board of ______________)
Your Board
____ 6. Use appropriate postage and send your materials to:
Criminal Background Check Program
2829 University Ave SE Ste 555
Minneapolis, MN 55414-4202
NOTE: To avoid delay, mail your materials directly to the Criminal Background Check
Program. Do not send them to the Board, or it will delay the background check.
If you have questions about the criminal background check process, please contact CBC Program staff at
criminal.background.check@state.mn.us or (651) 201-2822.
Vers. 3.2 (electronic), last updated on 2/15/2019
Important Tips to Improve Fingerprint Quality
Minn. Stat. § 214.075 requires a fingerprint-based criminal background check to obtain health professional licensure. To
fulfill this requirement, the applicant must provide high-quality fingerprints that will be transmitted to the FBI.
Some people have their fingerprints rejected by the FBI as “unclassifiable.”
Why Is This Important to Me?
Most criminal history results are received within two to three weeks. If the FBI rejects your fingerprints, you have to start
the background check over again by providing new fingerprints. Two to three weeks could become four to six weeks, six
to nine weeks, or more!
What Causes This? The following are some circumstances that can increase the chance of fingerprints being rejected:
• people who do a lot of work with their hands
• people who wash/disinfect their hands repeatedly
• people who are very active in their personal lives, including activities that are hard on fingertips, such as lifting
weights, rock climbing, playing guitar, or even gardening!
• people who handle a lot of paper or spend a lot of time typing
• exposure to chemicals, such as bleach, chlorine, acetone, antibacterial products, soaps, etc.
• age: skin becomes smoother and fingertip ridges are harder to capture as you get older
• ethnicity: some ethnic groups have naturally fine/smooth skin, e.g., Asian, Scandinavian, German
The combination of these factors leaves some people with very smooth or dry skin and “worn down” fingertip ridges. To
help minimize the chance of delays caused by poor quality fingerprints, you can do the following:
1. USE LOTION
The best thing you can do to avoid having your fingerprints rejected is to moisturize! Start using lotion on your
fingertips at least twice daily for several days before fingerprints are taken. This improves fingerprint quality by
reducing dryness and helping skin ridges to heal. We do not recommend using lotion on the day of your
fingerprinting appointment.
2. LIVESCAN
If possible, license applicants should try to find an agency that uses LiveScan (digital) fingerprint technology. Ink
fingerprints are legally acceptable, but digital equipment produces better images. Only the CBCP will digitially
transmit your prints. All other agencies should digitally scan your fingerprints and print out a hard copy
fingerprint card that you mail to the CBCP office. If the agency does not keep hard copy cards on hand, applicants
may request one be mailed to them by the CBCP. Examples of local law enforcement agencies to contact include
the following: county sheriffs, your state’s crime bureau, city police, tribal police, state patrol, licensed campus
police, military police, and any other government law enforcement agency. If local police agencies do not do
fingerprinting, they may be able to recommend qualified alternatives.
3. “LIFT LESS”
Lifting weights is hard on fingertips, especially free weights like dumbbells or kettlebells. At the end of each
repetition the weight in motion is stopped by your fingertips squeezing more tightly against the moving weight.
Even with very light weights, this has the effect of literally scraping the weight against the ridges of your
fingertips. This causes breaks, tears, and wearing down of the skin ridges that are essential for high quality
fingerprints. To maximize fingerprint quality, avoid using weights for several days before your fingerprints are
taken. In addition, avoid other activities that are hard on fingertips or dry out your skin, such as rock climbing,
exposure to chemicals and cleaners, getting a manicure, etc.
Please email or call if you have any other questions about fingerprinting or the background check process overall.
MN Health Licensing Boards
Criminal Background Check Program
651-201-2822
criminal.background.check@state.mn.us
These are ink fingerprints from a This is a LiveScan fingerprint from a person who
person who lifts weights two to three times/week. moisturized and avoided “hard” activity for five days.
Vers. 3.2 (electronic), last updated on 2/15/2019
Fingerprint Ridgeline Improvement over Time with Regular
Lotion & Reducing Activities That Are Hard on Fingertips
Work
Way of Life Washing
Moisturize at Least 2–3x per Day, and “Go Easy” on Your Hands to Get Better Prints
Vers. 3.2 (electronic), last updated on 2/15/2019
____________________________________
PRINT NAME HERE (LAST, FIRST)
Criminal Background Check Program
2829 University Ave SE Ste. 555
Form 1
Minneapolis, MN 55414-4202 Informed Consent:
Criminal Background Check for Licensure
Pursuant to Minn. Stat. § 214.075, a criminal background check is required for the initial license, license renewal or Board investigation
with one of the Minnesota Health Licensing Boards.
TENNESSEN WARNING: The information below, your fingerprints, and other identification information on the fingerprint card are being
requested so that a criminal background check can be conducted to determine whether you are qualified for licensure. You are not
legally required to provide the requested information; however, failure to provide this information will result in the Board denying you
licensure, as Minn. Stat. § 214.075, subd. 4, prohibits the Board from issuing a license to anyone “ . . . who refuses to consent to a
criminal background check or fails to submit fingerprints within 90 days after submission of an application for licensure.” Additionally,
failure of an applicant or licensee to provide the requested information is grounds for disciplinary action by the Board. Some charges or
convictions may preclude licensure, while others will not automatically remove you from consideration for licensure. This is dependent
upon the nature of the charge or conviction, the particular licensure statute that applies to you, and the Board’s determination of
whether the charge or conviction directly relates to the license and your ability to fulfill license requirements.
Your Current Name, Former Names, and Date of Birth will be used to help positively establish your identity and to conduct a criminal
background check. Your Sex as requested below refers to your biological status, and will be used to help positively establish your
identity and to conduct a criminal background check. Your fingerprints and other identification information will be collected on a
separate fingerprint card, and these also will be used to positively establish your identity and to conduct a criminal background check.
Providing your Social Security Number on the fingerprint card is optional for purposes of this background check; however, if provided,
this additional identifying information is helpful in ensuring that any criminal background records obtained are yours, and not records
relating to another person.
Access to the data you provide and any criminal history information the Board receives will be limited to individuals within the Board
whose job duties reasonably require access, such as Board staff responsible for licensing, investigation, discipline, and others involved
in the licensure or background check process. The BCA, the FBI, and the Office of the Legislative Auditor will also have access to the
information you provide. The information could also be released in response to a court order. The BCA and the FBI will not retain
submitted fingerprints except for a limited time for auditing purposes.
By signing below, you authorize the Board to send this information, your fingerprints and other identification information on the
fingerprint card to the BCA and FBI to conduct a criminal background check under Minn. Stat. § 214.075. You authorize those agencies
to send the Board, through its Criminal Background Check Program, any criminal history information that they possess.
I certify that the information I have provided is true and accurate to the best of my knowledge. I understand that providing
false information may result in denial of licensure or disciplinary action by the Board.
Signature Date
This authorization for release of data expires one year from the date of signature.
The Board is requesting both State and Federal checks on this person (fingerprint card submitted)
PLEASE PRINT LEGIBLY AND USE YOUR COMPLETE NAME, INCLUDING MIDDLE NAME
Last Name:
First Name: Middle Name:
Maiden, Alias, or Former Name(s):
Date of Birth: Sex:
Month/Day/Year M or F
MN Board you are applying to (e.g., “Dentistry,” “Nursing,” “Physical Therapy”):
You may challenge the accuracy and completeness of any information contained in a criminal history report that is provided to the Board. The
procedures to make such challenges are set forth in Minn. Stat. § 13.04; § 214.075, subd. 7; and Title 28 CFR § 16.34.
If you have questions about anything on this form, or if you would like more explanation, please contact the Criminal Background Check Program for the
Minnesota Health Licensing Boards at criminal.background.check@state.mn.us or (651) 201-2822.
Vers. 3.2 (electronic), last updated on 2/15/2019
Form 2
Criminal Background Check Program Informed Consent: Release of
2829 University Ave SE Ste. 555
Minneapolis, MN 55414-4202 Predatory Offender Registration Data
Pursuant to Board policy, a Predatory Offender Registration (POR) check is required for the initial license, license renewal or Board
investigation with one of the Minnesota Health Licensing Boards.
TENNESSEN WARNING: The information below is being requested so that a Predatory Offender Registration check can be conducted
as part of an overall background check to determine whether you are qualified for licensure. You are not legally required to provide the
requested information; however, failure to provide this information (except for Driver’s License Number & Issuing State, Current
Address, City, State & Zip Code, which are optional) may result in delay of your Predatory Offender Registration check, and a
subsequent delay in the Board being able to reach a licensure decision. If there is Predatory Offender Registration data relating to you,
that information will be evaluated by the Board in making a licensure determination. Some charges or convictions may preclude
licensure, while others will not automatically remove you from consideration for licensure. This is dependent upon the nature of the
charge or conviction, the particular licensure statute that applies to you, and the Board’s determination of whether the charge or
conviction directly relates to the license and your ability to fulfill license requirements.
Your Current Name, Former Names, and Date of Birth will be used to help positively establish your identity and to conduct a Predatory
Offender Registration check. Your Sex as requested below refers to your biological status, and will be used to help positively establish
your identity and to conduct a Predatory Offender Registration check.
Providing your Driver’s License Number & Issuing State, Current Address, City, State & Zip Code, is optional; however, if provided, this
additional identifying information is helpful in ensuring that any Predatory Offender Registration records obtained are yours, and not
records relating to another person.
Access to the data you provide and any Predatory Offender Registration information the Board receives will be limited to individuals
within the Board whose job duties reasonably require access, such as Board staff responsible for licensing, investigation, discipline, and
others involved in the licensure or background check process. The BCA and the Office of the Legislative Auditor will also have access
to the information you provide. The information could also be released in response to a court order. If you are determined to have
Predatory Offender Registration records, the BCA may use information you provide to update your registration records, and also to
notify appropriate authorities of any noncompliance with your registration requirements.
By signing below, I authorize and grant my informed consent to the BCA to release to the Board, through its Criminal
Background Check Program, any information contained about me in the Minnesota Predatory Offender Registry, including,
but not limited to, information related to registrations which may have occurred when I was a juvenile.
I hereby release the BCA and the Board from any and all actions and causes of action, of any kind and nature whatsoever,
past, present and future, arising out of the release of information obtained with this consent.
I certify that the information I have provided is true and accurate to the best of my knowledge. I understand that providing
false information may result in denial of licensure or disciplinary action by the Board.
Signature Date
This authorization for release of data expires one year from the date of signature.
PLEASE PRINT LEGIBLY AND USE YOUR COMPLETE NAME, INCLUDING MIDDLE NAME
Last Name:
First Name: Middle Name:
Maiden, Alias, or Former Name(s):
Date of Birth: Sex:
Month/Day/Year M or F
Driver’s License Number: DL Issuing State:
Current Address:
City, State, ZIP Code:
MN Board you are applying to (e.g., “Dentistry,” “Nursing,” “Physical Therapy”):
You may challenge the accuracy and completeness of any information contained in Predatory Offender Registration information that is provided to the
Board. The procedures to make such challenges are set forth in Minn. Stat. § 13.04.
If you have questions about anything on this form, or if you would like more explanation, please contact the Criminal Background Check Program of the
Minnesota Health Licensing Boards, at (651) 201-2822 or criminal.background.check@state.mn.us.
Vers. 3.2 (electronic), last updated on 2/15/2019
Form 3
Criminal Background Check Program Identity Verification Form
2829 University Avenue SE, Suite #555 For Fingerprinting
Minneapolis, MN 55414-4202
Pursuant to Minn. Stat. § 214.075, a criminal background check is required for the initial license, license renewal or Board investigation with one of
the Minnesota Health Licensing Boards.
INSTRUCTIONS FOR LICENSE APPLICANT:
____ 1. Bring this Identity Verification Form to your fingerprinting appointment.
____ 2. Bring a valid government-issued photo ID to your fingerprinting appointment.
____ 3. While observed by the person taking fingerprints, sign this form below AND also sign fingerprint card.
Last Name:
First Name: Middle Name:
Maiden, Alias or Former Name(s):
Date of Birth: Sex:
Month/Day/Year M or F
Type of Photo ID: Your Contact Phone #:
Driver License , Passport, Military ID, Tribal ID, etc.
Government Entity that issued ID : Your email address:
e.g. “Minnesota,” “Iowa,” etc.
Photo ID Number: Board applying to:
Driver’s License Number, Passport Number, etc. e.g. “Dentistry,” “Nursing,” “Psychology” etc.
Signature of License Applicant Date
By signing above I certify that I am the Applicant and that the information I have provided is truthful. I authorize the Board to
use the information I provide on this form to verify my identity.
INSTRUCTIONS FOR OFFICER / FINGERPRINTING TECHNICIAN:
____ 1. Examine Applicant photo ID, then confirm ID type and photo ID # above.
____ 2. Have Applicant sign this form AND the fingerprint card in your presence.
____ 3. You sign and date below AND ALSO sign fingerprint card.
____ 4. Enter your badge number if you have one (law enforcement) or the agency/company tax ID number (private vendor).
____ 5. Take fingerprints and return card to Applicant for mailing.
Agency/Company: Work Phone #:
Employee Name: Badge # (if any) / Tax ID #:
Printed Name
___
Signature of Law Enforcement Official, MN HLB CBC Staff Date of Fingerprinting
Or Fingerprinting Technician
By signing above I certify that I personally examined the photo ID of the applicant, captured their fingerprints on
an approved fingerprint card (FD-258), and personally observed them sign this form and the fingerprint card.
If you have questions, please contact Criminal Background Check Program staff at (651) 201-2822 or criminal.background.check@state.mn.us..
Vers. 3.2 (electronic), last updated on 2/15/2019
