Washington State Department of Corrections (DOC)



REQUEST FOR CRIMINAL HISTORY RECORD INFORMATIONWASIS/NCIC III CHECK NCIC / WACIC CHECK FORMCHECKBOX Routine FORMCHECKBOX UrgentDate of Request: FORMTEXT ?????Type of Request: FORMCHECKBOX Classification Update FORMCHECKBOX Visitor re: FORMCHECKBOX Volunteer FORMCHECKBOX IntakeOffender FORMTEXT ????? FORMCHECKBOX Contract Employee FORMCHECKBOX PSI FORMCHECKBOX Furlough Sponsor FORMCHECKBOX Prospective Employee FORMCHECKBOX ESR / Risk FORMCHECKBOX Update Field File FORMCHECKBOX Firearms Requalification FORMCHECKBOX OOS Investigation FORMCHECKBOX Update Central File FORMCHECKBOX Vendor/Maintenance Worker FORMCHECKBOX Release/ORP/Parole Investigation FORMCHECKBOX Wants and Warrants FORMCHECKBOX Other FORMTEXT ?????REQUIRED DATA:DOC Number FORMTEXT ?????SID Number FORMTEXT ?????FBI Number FORMTEXT ?????Full Legal Name (Last, First, Middle) FORMTEXT ?????Date of Birth FORMTEXT ?????Sex FORMTEXT ?????Race FORMTEXT ?????OTHER DATA:Maiden Name / Alias FORMTEXT ?????Birthplace FORMTEXT ????? Maiden Name / Alias FORMTEXT ?????Citizenship FORMTEXT ?????Maiden Name / Alias FORMTEXT ?????Hair FORMTEXT ?????Eyes FORMTEXT ?????SSN FORMTEXT ?????Height FORMTEXT ?????Weight FORMTEXT ?????Current Washington State Driver's License FORMCHECKBOX Yes FORMCHECKBOX NoLicense Number: FORMTEXT ?????Mail Stop: FORMTEXT ?????Address of Submitting Office (if no mail stop) FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX INTAKE/FOS – CCO SUBMIT FINGERPRINT CARDS TO YOUR LOCAL RECORDS OFFICE.PERSON MAKING REQUEST:Name(Print) FORMTEXT ?????Title FORMTEXT ?????Date FORMTEXT ?????:DateInitialsCheck boxes for Employment and Visitor requests only.Clear Criminal History FORMCHECKBOX Yes FORMCHECKBOX NoClear Wants and Warrants FORMCHECKBOX Yes FORMCHECKBOX NoThe contents of this document may be eligible for public disclosure. Social Security Numbers are considered confidential information and will be redacted in the event of such a request. This form is governed by Executive Order 00-03, RCW 42.56, and RCW 40.14. ................
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