Contents
-
Section 4: Record Check Authorization (page LI0024)
The information entered in this section is used to perform a Record Check on the applicant.
Applicant Name
The name will be carried forward from the entry made on the previous page.
Record Check Reason
Since this page occurs in the Initial Visit Request flow, the reason is pre-populated with License Application/Reapplication.
Other Last Names Used: (separated by commas)
This field is used to capture any other last names used by the applicant other than the name entered on the Applicant Information page.
Other First Names Used: (separated by commas)
This field is used to capture any other first names used by the applicant other than the name entered on the Applicant Information page.
Date of Birth
The date of birth will be carried forward from the entry made in Section 1.
SSN (Social Security Number)*
Enter the Social Security Number for the applicant.
Contact Phone
Enter the telephone number for contact in this field using the format ###-###-####.
Birth City*
Enter the name of the city in which the applicant was born in this field.
Birth State*
Select the name of the state in which the applicant was born in this field using the down arrow () next to the field. If the applicant was born in another country, select Out of Country in this field.
Conviction Question*
The following question requires a Yes or No answer.
"Has applicant ever been convicted or found by a court to have committed fraud, felony or an offense involving violence or unlawful sexual activity, or other bodily injury to another person, including, but not limited to abuse, neglect or sexual activity with a child?"
Authorization Signed?*
If the Record Check Authorization form contains a signature, enter Yes in this field. If no signature date has been entered, enter No in this field.
Date Authorized
Enter the date the date that appears on the Record Check Authorization form in the format MM/DD/YYYY. This field is required if the form has been signed.
More:
Submitting Section 4 (LP)