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Cori acknowledgement form massachusetts

(cori) acknowledgement form - Mass - mass 2026

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The document is a Criminal Offender Record Information (CORI) Acknowledgement Form used by the Division of Professional Licensure to obtain permission from license applicants or current licensees for conducting CORI checks. It outlines the process for submitting personal information to the Department of Criminal Justice Information Services, the validity period of the authorization, and the conditions under which subsequent checks may occur. The form requires verification of identity either in person or by a notary public.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal information. Enter your last name, first name, middle name, and suffix as required fields.
Provide your maiden name or any other names you have been known by, along with your date of birth and place of birth.
Complete the section for the last six digits of your Social Security Number, sex, height, eye color, and driver's license or ID number along with the state of issue.
List your current and former addresses accurately. Ensure all details are correct to avoid processing delays.
In Section A or B, ensure that a DPL employee or notary public verifies your identity. This step is crucial for the acceptance of the form.
Finally, sign and date the form at the designated areas to provide consent for the CORI check.

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How do I get a CORI form in Massachusetts?

Download and print out the Personal CORI Request Form from the Department of Criminal Justice Information Services (DCJIS) website. Or call DCJIS at 617-660-4600 (for TTY, call 617-660-4606) to get the form by mail. It is important to write neatly. DCJIS may send back forms that are hard to read.