Homepage Fill Out Your 41 Ls Form
Article Structure

The 41 Ls form, officially titled the Request for Live Scan Service, serves as a critical tool for applicants seeking to obtain background checks through electronic fingerprinting. This form captures essential information about the applicant, including identifying details such as their name, date of birth, and social security number. It also specifies the type of application being submitted, be it for job placement, licensing, certification, or a permit. The 41 Ls form requires a designated agency to receive and manage the criminal history information, identified by a unique five-digit mail code. Among its components, the form emphasizes the importance of accurate contact details and mandates the inclusion of specific identifiers, like the applicant's height, weight, and physical description, which aid in verifying identity. Additionally, sections are devoted to documenting the service level requested from the Department of Justice (DOJ) and the FBI, while also accommodating resubmission tracking with the Original ATI Number. Understanding how to properly fill out this form is crucial for a smooth and efficient background check process, thereby facilitating employment or credentialing within regulated sectors.

41 Ls Example

REQUEST FOR LIVE SCAN SERVICE

FORM 41-LS Rev. 07/11

Applicant Submission

ORI:

 

 

 

 

 

 

 

 

 

 

 

 

Type of Application:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Code assigned by DOJ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Job Title or Type of License, Certification or Permit:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Address Set Contributing Agency:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency authorized to receive criminal history information

 

 

 

 

Mail Code (five-digit code assigned by DOJ)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street No.

Street or PO Box

 

 

 

 

 

 

 

 

 

 

 

 

Contact Name (Mandatory for all school submissions)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

 

 

 

Zip Code

 

 

 

 

Contact Telephone No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Applicant:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Please print)

 

Last

 

 

 

 

 

 

 

 

 

 

 

 

First

 

 

 

 

 

 

 

MI

 

 

Alias:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver’s License No:

 

 

 

 

 

 

 

 

 

 

 

Last

 

 

 

 

 

 

 

 

 

 

 

 

First

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

Sex:

 

 

 

 

Male

 

 

Female

Misc. No. BIL -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Agency Billing Number

 

Height:

 

 

 

 

Weight:

 

 

 

 

 

 

 

 

 

 

 

 

 

Misc. Number:

 

 

 

 

 

 

 

 

 

Eye Color:

 

 

 

Hair Color:

 

 

 

 

 

 

 

 

 

 

 

 

Home Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street No.

 

 

Street or PO Box

 

Place of Birth:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State and Zip Code

 

 

Social Security Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OCA No. (Applicant Social Security No.)

 

 

 

 

Level of Service:

 

 

DOJ

 

FBI

 

If resubmission, list Original ATI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer: (Additional response for agencies specified by statute)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street No.

 

Street or PO Box

 

 

 

 

 

 

 

 

 

 

Mail Code (five digit code assigned by DOJ)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

City

 

State

Zip Code

 

 

Agency Telephone No. (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Live Scan Transaction Completed By:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Operator

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transmitting Agency

 

 

 

 

 

 

 

 

 

ATI No.

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount Collected/Billed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ORIGINAL – Live Scan Operator; SECOND COPY – Applicant; THIRD COPY (if needed) – Requesting Agency

Form Characteristics

Fact Name Description
Purpose The 41 LS form is used to request Live Scan fingerprinting services for background checks.
Governing Law In California, the use of the 41 LS form is governed by California Penal Code Section 11105.
Applicant Information The form requires detailed information about the applicant, including their name, date of birth, and contact information.
Service Levels Applicants can choose between different levels of service, which include Department of Justice (DOJ) and FBI background checks.
Submission Completed forms must be submitted by authorized agencies to ensure the applicant's criminal history is accurately checked.

Guidelines on Utilizing 41 Ls

Filling out the Live Scan Service Form 41-LS is an essential step in ensuring that your application processes smoothly. This form requires specific information about both the applicant and the agency requesting the background check. Here are the steps to guide you through the completion of this important document.

  1. Begin by entering the ORI (Originating Agency Identifier) in the designated field. This code is assigned by the Department of Justice (DOJ).
  2. Specify the type of application you are submitting by selecting the appropriate option in the form.
  3. Fill in the job title or the type of license, certification, or permit you are applying for.
  4. Provide the agency's address, including street number, PO Box, city, state, and zip code.
  5. Indicate the set contributing agency, which is the agency authorized to receive your criminal history information.
  6. Enter the five-digit mail code assigned by the DOJ.
  7. Input the name of the contact person (this is mandatory for school submissions) and their telephone number.
  8. On the next section, print your name clearly. Include your last name, first name, and middle initial.
  9. If you have any aliases, list them on the form.
  10. Provide your driver’s license number, including your last name, first name, and date of birth.
  11. Indicate your sex by selecting male or female.
  12. Fill in any miscellaneous numbers, such as agency billing number (BIL), height, weight, eye color, and hair color.
  13. Complete your home address, using street number, PO Box, city, state, and zip code.
  14. State your place of birth, including city, state, and zip code.
  15. Input your social security number and the OCA number.
  16. Select the level of service you require: DOJ or FBI.
  17. If this is a resubmission, include the original ATI number.
  18. Provide your employer's name, full address, and mail code (if required by statute).
  19. Fill in the telephone number for the agency (optional).
  20. Lastly, the live scan transaction must be completed by an authorized operator. Include their name and the date of completion.
  21. Record the transmitting agency's ATI number and the amount collected or billed for the service.

Once you have filled out the form, it will need to be submitted to the appropriate agency. Ensure that you have retained copies for your records. The Live Scan operator will keep the original form, while you should hold on to the second copy for your documentation. If there are any specific instructions from the requesting agency, be sure to follow those carefully to expedite processing.

What You Should Know About This Form

What is the 41-LS form and when is it used?

The 41-LS form, also known as the Request for Live Scan Service Form, is used to request a live scan fingerprinting service for background checks. This form is commonly required for various licenses, certifications, and permits, particularly in sectors that need criminal history information. It is crucial for both applicants and agencies that require this data for employment or certification purposes.

How do I complete the 41-LS form?

To complete the 41-LS form, fill out all mandatory fields, including personal information like your name, address, and Social Security number. Ensure to indicate the agency's name that will receive the criminal history information and provide the appropriate contact details. Specify your type of application and include an agency billing number if applicable. Double-check to ensure all information is accurate before submission.

Where do I submit the completed 41-LS form?

The completed 41-LS form should be submitted to the designated Live Scan service provider. This may be a law enforcement agency or a private service provider authorized to conduct live scans. Make sure you have arranged an appointment in advance, as walk-ins may not be accepted.

What information do I need to provide on the form?

You will need to provide personal details such as your name, date of birth, sex, height, weight, eye color, hair color, and place of birth. Additionally, you must include your driver’s license number, Social Security number, and the agency mailing address. Be prepared to provide contact information for the agency that requires the background check.

Can I request a resubmission using the 41-LS form?

Yes, if you need to resubmit your request, you will need to list the original ATI number on the form. This number connects your previous submission and helps the agency track your background check history. Ensure that you provide accurate details to facilitate the resubmission process.

How is the information on the 41-LS form used?

The information you provide on the 41-LS form is used to conduct background checks through the Department of Justice (DOJ) and, in some cases, the FBI. The results are essential for assessing an applicant's suitability for positions or licenses that require a clean criminal record.

What happens after I submit the 41-LS form?

Once you submit the form and complete the live scan process, the results will be transmitted to the designated agency. Depending on their procedures, you may receive a copy of the results or additional instructions regarding the next steps. Processing times can vary, so check with the agency for specific timelines.

Is there a fee for submitting the 41-LS form?

Yes, there is usually a fee associated with the live scan transaction, which can vary by provider. This fee may cover the live scan process, as well as the processing of your background check through the DOJ or FBI. It is advisable to confirm the fees with the service provider before completing your request to ensure you are adequately prepared.

Common mistakes

Filling out the 41-LS form can seem straightforward, but many applicants make mistakes that could delay the processing of their Live Scan request. Understanding these common pitfalls can help ensure your application goes smoothly.

One of the most frequent errors is neglecting to provide all required information. For instance, the applicant's name, including middle initial, must be clearly printed. Missing even a minor detail like an initial can lead to complications. Incomplete sections often necessitate a resubmission, causing unnecessary delays.

Another common mistake is incorrect entry of personal identification numbers. This includes the Driver’s License number and Social Security number. If any digits are wrong, it can prevent the Department of Justice (DOJ) from accurately matching your records. Always double-check these numbers for accuracy.

Furthermore, some applicants overlook the importance of indicating the correct level of service. On the form, you must specify whether you require DOJ services, FBI services, or both. Selecting the appropriate option is crucial for the application’s intended purpose, whether for employment or licensure.

Additionally, many individuals fail to fill in the “Mail Code” section. This five-digit code is essential for identifying the contributing agency. Without it, the application might not reach the right destination. Researching this code beforehand can save time and prevent frustration.

Not including a contact person can also be a significant oversight, especially for school submissions. Applicants often forget to fill in the contact name, which is mandatory. This small detail helps facilitate communication if there are any questions regarding your submission.

Errors related to the physical description fields, such as height, weight, eye color, and hair color, can lead to inconsistencies. These fields serve an important identification purpose. Submitters should take care to provide descriptions that accurately reflect their current appearance.

Lastly, applicants sometimes misunderstand the resubmission instructions. If you are resubmitting an application, it’s critical to correctly list the Original ATI Number. Without this additional identifier, your application may not be processed efficiently, leading to delays in obtaining your Live Scan results.

By being aware of these common mistakes and taking the time to fill out the 41-LS form thoroughly, you can help ensure a smoother application process. It pays to double-check your entries and clarify any uncertainties you might have before submission.

Documents used along the form

When completing the Live Scan Service Form 41-LS, several other documents may be required or helpful in the process. Each of these documents serves a specific purpose, ensuring that the applicant’s background check is thorough and accurate. Here’s a list of some of these essential forms and documents.

  • Live Scan Request Form: This document provides the specific details regarding the live scan service applicants are requesting, including their identification and the type of background check needed.
  • State Identification Card: A state-issued ID may be required to verify the applicant's identity during the process. It ensures that all information matches what is provided on the live scan form.
  • Criminal History Disclosure Form: Applicants might need to fill out a form disclosing any prior criminal history. This form helps clarify the context of the background check.
  • Consent to Release Information: This document allows the agency conducting the background check to access the applicant's criminal history. It is a crucial step in ensuring compliance with privacy laws.
  • Fingerprint Card: In some cases, a standard fingerprint card may be used if the live scan process is not available or practical. This serves as a physical record of the applicant's fingerprints.
  • Employer Background Check Authorization: If the request for live scan is work-related, this document grants permission for the employer to use the results for hiring or licensing decisions.
  • Payment Verification Receipt: Applicants may need to provide proof of payment for the live scan service, indicating that the transaction has been completed successfully.
  • Additional Identification Documents: This can include documents like a passport or social security card, supporting the applicant's identity and background information during the process.

These documents play an essential role in ensuring that the live scan process runs smoothly and effectively. Each form serves to verify identity, provide necessary disclosures, and facilitate communication between the involved agencies.

Similar forms

  • FBI Fingerprint Card: Similar to the 41 Ls form, the FBI Fingerprint Card is used for conducting background checks. Both documents require personal information and help agencies ensure an individual’s suitability for certain positions or licenses.
  • Background Check Release Form: This document allows an employer to conduct a background check on an applicant. Like the 41 Ls form, it collects vital personal data and signifies consent for a thorough investigation into the applicant's history.
  • Employment Application Form: An employment application collects personal and professional background details from job seekers. Its purpose is similar; both aim to gather essential information about an individual before they can be considered for a position or role.
  • Criminal Record Request Form: This form is used to request an individual’s criminal history. It is aligned with the 41 Ls form's purpose, as both facilitate access to important background information that helps assess an applicant's qualifications.
  • Licensing Application Form: This form is often required for various licenses and certifications. Like the 41 Ls form, it necessitates personal and identifying information and serves as a critical step in the approval process for professional credentials.

Dos and Don'ts

When filling out the 41-LS form, attention to detail is crucial. Here are five important dos and don’ts to consider:

  • Do ensure all required fields are completed accurately.
  • Do double-check the spelling of names and addresses.
  • Do provide a valid contact number for follow-up questions.
  • Do confirm the agency information is current and correct.
  • Do keep a copy of the completed form for your records.
  • Don't leave any mandatory fields blank, as this can delay processing.
  • Don't use nicknames or initials; provide full names as required.
  • Don't forget to sign and date the form where indicated.
  • Don't provide incorrect billing information; it may lead to complications.
  • Don't overlook the deadline for submission; timely filing is essential.

Misconceptions

  • Misconception 1: The 41 Ls form is only for individuals applying for specific jobs.

    This form is used for a variety of purposes, not solely limited to employment. It is often necessary for background checks for licenses, certifications, and permits across multiple sectors, including education, healthcare, and more.

  • Misconception 2: Submitting the 41 Ls form ensures immediate approval.

    While submitting the form is an important step, it does not guarantee swift approval. Processing times can vary, and additional documentation or background checks might be required before a decision is made.

  • Misconception 3: Only criminal history is reviewed when the 41 Ls form is processed.

    Although the form is primarily associated with criminal history checks, other factors may also be considered depending on the purpose of the background check. This may include verification of identity and other relevant personal information.

  • Misconception 4: The 41 Ls form can be submitted without a contact person listed.

    For school submissions and some other applications, a contact name is mandatory. This ensures that there is a liaison who can address any inquiries or issues that may arise during the processing of the form.

  • Misconception 5: The 41 Ls form is the same as the traditional fingerprinting process.

    While both processes involve background checks, the 41 Ls form specifically pertains to Live Scan services, which utilize digital fingerprinting technology. This method typically offers faster results and greater efficiency compared to traditional ink methods.

Key takeaways

Filling out and utilizing the 41 Ls form can streamline the process of obtaining a live scan service. Here are ten key takeaways to ensure the form is completed accurately and used effectively:

  1. The 41 Ls form, officially known as the Request for Live Scan Service, is essential for fingerprinting and background checks.
  2. All fields marked as mandatory must be completed to avoid processing delays.
  3. The Agency Address should include the complete mail code, consisting of a five-digit code assigned by the Department of Justice (DOJ).
  4. Providing accurate information about the applicant is crucial; their full name, date of birth, and social security number must be clearly printed.
  5. Indicate the level of service required, specifying whether it is DOJ, FBI, or both.
  6. Including the original ATI number is necessary if the submission is a resubmission.
  7. The employer's information is often required, especially when mandated by statute.
  8. The form requires a contact name for submissions related to schools; failing to include this can result in rejections.
  9. Upon completion, the form should have three copies distributed appropriately: original for Live Scan operator, second for the applicant, and third for the requesting agency if needed.
  10. Date and name of the live scan operator must be included, as this verifies the transaction took place.

Completing the 41 Ls form accurately plays a significant role in facilitating an efficient live scan service process.