Ny fingerprint waiver form submission online 2011-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Last Name, First Name, and Middle Initial in the designated fields.
3. Select your Sex by checking either Male or Female.
4. Input your Date of Birth in the format Month/Day/Year.
5. If applicable, provide any Alias or Maiden Name.
6. Enter your current Street Address, City/State, and Zip Code.
7. If this is a new address since your last fingerprinting, check the box provided.
8. Fill in the New Facility/Provider ID#, name, street address, city/state, and zip code for your current application.
9. Indicate your Current Role by checking the appropriate box from the options provided.
10. Answer whether you have been previously fingerprinted by selecting Yes or No.
11. If Yes, list previous Facility/Provider/Agency details as required.
12. Finally, ensure you sign and date the form before submission.

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