Cna live scan form 2026

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The document is a Request for Live Scan Service form from the California Department of Justice, specifically for applicants seeking certification as Certified Nurse Assistants (CNA). It includes sections for personal information, agency details, and criminal history checks required for CNA certification.

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Click ‘Get Form’ to open the CNA Live Scan form in our editor.
Begin by filling in the 'Applicant Submission' section. Enter your ORI code and select 'CNA Certification' as the type of application.
In the 'Contact Name' field, provide a mandatory contact name for school submissions. Ensure all details are accurate.
Complete your personal information: fill in your name, date of birth, sex, driver's license number, and social security number.
Next, input your physical characteristics such as height, weight, eye color, and hair color in the designated fields.
If applicable, include your place of birth and agency billing number. Specify the level of service required (DOJ or FBI).
Finally, review all entries for accuracy before saving or printing your completed form using our platform's features.

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How do I get a live scan form in California?

Individuals can obtain a Request for Live Scan form LIC 9163 or from any local Community Care Licensing Division office.

What is the difference between a live scan and a background check?

California laws regarding live scan requirements The types of jobs that typically need live scan fingerprinting and background checks are employees who are in a position of trust for some of Californias most vulnerable citizens, such as the elderly, dependent adults and minors.

What is a 283B form?

A: 283B is the form number that you will find on the bottom left hand corner of the Certified Nurse Assistant (CNA) and/or Home Health Aide (HHA) Initial Application. Your school should give this form to you when you complete a CNA program. It must be filled out and signed by the RN in charge of your CNA program.

What is a live scan form for?

Live scan is digital fingerprint submission transmitted electronically to the California Department of Justice (DOJ). Live scan is an automated service for criminal history background checks that may be required as a condition of employment, licensing, certification, foreign adoptions or VISA/Immigration clearances.

What is the point of a LiveScan?

Live Scan is inkless electronic fingerprinting. The fingerprints are electronically transmitted to the Department of Justice (DOJ) for completion of a criminal record check.

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What is a Livescan form?

The 10-digit Applicant Transaction Identifier (ATI) number that appears at the bottom of the Request for Live Scan Service form. The ATI number always appears in the following sequence: 1 Letter; 3 Numbers; 3 Letters; 3 Numbers.