Accurate Biometrics Application Accurate Biometrics
Phone: 773-685-5699 Fax 773-685-5433
4849 N. Milwaukee Suite 101
Chicago, IL 60640
Website: www.accuratebiometrics.com
National Louis University UCIA Thank you for choosing Accurate Biometrics for your fingerprinting needs. PLEASE PROVIDE THE FOLLOWING INFORMATION (Please print clearly.)
Last Name: First Name: Middle Initial:
Daytime Phone:
Date of Birth:
Sex: (circle one)
Male
Female
Race: (circle one) Black
Hispanic
Asian
White
American Indian/Alaskan
REQUESTER INFORMATION
Name:
Agency Name: < not applicable >
Street Address: State:
Zip Code:
I, the undersigned, authorize Accurate Biometrics to capture and transmit my fingerprints and above- noted demographic data to the Illinois State Police. I understand that the Illinois State Police will return the results of the fingerprint search to the Requestor listed above. Signature: Date: ------------------------ (Do Not Write Below This Line. - - - For Office Use Only) ---------------------- F.P. Tech: TCN: Date Fingerprinted:
50 / MAT (ECE) Handbook
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