What is the purpose of this form?

Form 212A is used exclusively for the purpose of local Police Department and State Agencies, to obtain background information for the purposes of employment, licensing and local ordinances.

How do I find out the local licensing authority for my application?

The local licensing authority depends on your area of residence. You must contact your local Police Department or the State Agency in which you are requesting licensing.

Will I receive the Criminal History Record Information requested?

The Criminal History Record Information (CHRI) will not be sent to you. This information is used exclusively by the Local Police Department or the State Agency to complete your request.

What is an ORI Number and why is it important?

The Originating Agency Identifier (ORI) is a unique number assigned to each Police Department and State Agency. It's a way to identify who made the request and where the response should be returned. The form will be rejected if the ORI is not correct or not indicated. There are no refunds for rejected form.

Please verify the ORI with the Police Department or State Agency before submitting the form.

Request for a Criminal History Record Information for a Noncriminal Justice Purposes

Service Information

Requests for a Criminal History Record Information (CHRI), for Non Criminal Justice purposes can be submitted here.

The online 212A Form should be used only after consultation with your local Police Department or the State Agency that is responsible for the type of licensing needed. You must first obtain an Originating Agency Identifier (ORI) Number from the licensing department to complete this form. Incorrect ORI Number may result in non-processing of your form.

Each submission costs $20.00, payable by Visa, MasterCard, Discover, or American Express credit or debit card.

This form can't be used for a personal background check.