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pdfPERSONAL IDENTIFICATION
SEE REVERSE SIDE FOR FURTHER INSTRUCTIONS
TYPE OR PRINT ALL INFORMATION IN BLACK
LAST NAME
NAM
LEAVE BLANK
FBI
MIDDLE NAME
FIRST NAME
FD-353 (Rev. 9-9-13) 1110-0046
SIGNATURE OF PERSON FINGERPRINTED
FINGERPRINTS SUBMITTED BY
DATE OF BIRTH DOB
Month
Day
Year
RESIDENCE OF PERSON FINGERPRINTED
SEX
DATE FINGERPRINTED
RACE
HGT.
WGT.
EYES
HAIR
PLACE OF BIRTH
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
NAME
LEAVE BLANK
SOCIAL SECURITY NO.
ADDRESS
CLASS
MISCELLANEOUS NO.
FINGERPRINTED BY
REF.
SCARS AND MARKS
1. R. THUMB
6.L. THUMB
2. R. INDEX
7. L. INDEX
LEFT FOUR FINGERSTAKEN SIMULTANEOUSLY
3. R. MIDDLE
4. R. RING
8. L. MIDDLE
9. L. RING
L. THUMB
R. THUMB
5. R. LITTLE
10. L. LITTLE
RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY
POB
FEDERAL BUREAU OF INVESTIGATION
UNITED STATES DEPARTMENT OF JUSTICE
CRIMINAL JUSTICE INFORMATION SERVICES DIVISION, CLARKSBURG, WV 26306
PERSONAL IDENTIFICATION
To obtain classifiable fingerprints:
1. Use printer’s ink.
2. Distribute ink evenly on inking slab.
3. Wash and dry fingers thoroughly.
4. Roll fingers from nail to nail, and avoid allowing fingers to slip.
5. Be sure impressions are recorded in correct order.
6. Notate in the appropriate finger blocks if applicant is missing one or more fingers for any reason. If not missing, all ten impressions must
be provided with scars and deformities notated.
7. If some physical condition makes it impossible to obtain perfect impressions, submit the best that can be obtained.
8. Examine the completed prints to see if they can be classified, bearing in mind the following:
Most fingerprints fall into the patterns shown below. Other patterns occur infrequently and are not shown here.
FD-353 Personal Identification Privacy Act Statement
Authority: The FBI's acquisition, preservation, and exchange of fingerprints and
PASTE
PHOTO HERE
(OPTIONAL)
associated information is generally authorized under 28 U.S.C. 534. Depending on
the nature of your application, supplemental authorities include Federal statutes,
State statutes pursuant to Pub.L. 92-544, Presidential Executive Orders, and federal
regulations. Providing your fingerprints and associated information is voluntary;
however failure to do so may affect completion or approval of your application.
Social Security Account Number (SSAN). Your SSAN is needed to keep records
accurate because other people may have the same name and birth date. Pursuant to
the Federal Privacy Act of 1974 (5 USC 552a), the requesting agency is responsible
for informing you whether disclosure is mandatory or voluntary, by what statutory or
other authority your SSAN is solicited, and what uses will be made of it. Executive
Order 9397 also asks Federal agencies to use this number to help identify individuals
in agency records. Providing of the SSAN is voluntary.
Principal Purpose: Certain determinations, such as employment, licensing, and
security clearances, may be predicated on fingerprint-based background checks.
Your fingerprints and associated information/biometrics may be provided to the
employing, investigating, or otherwise responsible agency, and/or the FBI for the
purpose of comparing your fingerprints to other fingerprints in the FBI's Next
Generation Identification (NGI) system or its successor systems (including civil,
criminal, and latent fingerprint repositories) or other available records of the employing,
investigating, or otherwise responsible agency. The FBI may retain your fingerprints
and associated information/biometrics in NGI after the completion of this application
and, while retained, your fingerprints may continue to be compared against other
fingerprints submitted to or retained by NGI.
Routine Uses: During the processing of this application and for as long thereafter as
FD-353 (Rev. 9-9-13)
your fingerprints and associated information/biometrics are retained in NGI, your
information may be disclosed pursuant to your consent, and may be disclosed without
your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses
as may be published at any time in the Federal Register, including the Routine Uses
for the NGI system and the FBI's Blanket Routine Uses. Routine uses include, but are
not limited to, disclosures to: employing, governmental or authorized non-governmental
agencies responsible for employment, contracting, licensing, security clearances, and
other suitable determinations; local, state, tribal, or federal law enforcement agencies;
criminal justice agencies; and agencies responsible for national or public safety.
File Type | application/pdf |
File Modified | 2013-10-25 |
File Created | 2010-03-03 |