Form 823F FAST Application

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
FAST Commercial Driver Application - MX

Approved OMB No. 1651-0121
Exp. 10-31-2010

Please type or print
1a. (Check one box only)

First time applicant

Renewal

1b. Border crossings most frequently used (Example, Laredo)

Replacement

If renewal or replacement, current FAST Card No:

SECTION A - PERSONAL INFORMATION
2. Last/Paternal Name

2a. Maternal name

3. First name

4. Middle name (in full)

5. Other names used (e.g., maiden name, former name)

Nickname

4a. Suffix
7. Date of birth (yyyy/mm/dd)

6. Gender
Male

City

8.

Female

Country

State

Place of birth
9. Citizenship (Check all that apply.)
Canadian citizen

10. Residence

U.S. citizen

Mexican citizen

Other (Must Specify)

Canada

United States

Mexico

11. Proof of citizenship/residency/immigration status (Attach copies)
U.S. Alien Registration No.

or

Border Crossing Card No.

Birth Certificate No.

Passport No.
(Expiration Date)
(yyyy/mm/dd)

Country of Issuance
Other

Type of document

No.
(Expiration Date)
(yyyy/mm/dd)

Drivers license No.
(Attach Copy)

SECTION B - ADDRESS HISTORY FOR THE LAST 5 YEARS

12. Current address (yyyy/mm) 13. Street Address
As of what
date?
16. Country

17. State

(Expiration Date)
(yyyy/mm/dd)

State and Country of Issuance

18. Postal/Zip Code

Apt. No.

14. City

19. Home telephone

15. Colonia/Neighborhood

20. Business telephone/Cell phone number
Ext.

Mailing address if different from residential address
21. Street Address

23. Colonia/Neighborhood

24. Country

Apt. No.
25. State

22. City
26. Postal/Zip Code

Previous residential addresses if current residence is less than five years (address history continued on page 4).
27.

(yyyy/mm)

(yyyy/mm)

From:

31. Country
(yyyy/mm)

(yyyy/mm)

From:

32. State

35. Street Address

33. Postal/Zip Code
Apt. No.

36. City

To:
38. Country

37. Colonia/Neighborhood
41.

29. City

To:

30. Colonia/Neighborhood
34.

Apt. No.

28. Street Address

(yyyy/mm)

(yyyy/mm)

From:
44. Colonia/Neighborhood

39. State

42. Street Address

40. Postal/Zip Code
Apt. No.

43. City

To:
45. Country

46. State

47. Postal/Zip Code

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this
information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0121. The estimated
average time to complete this application is 40 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border
Protection Office of Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.

CBP Form 823F (07/10)

SECTION C - EMPLOYMENT HISTORY FOR THE LAST 5 YEARS

48. Current employer
(yyyy/mm)
From:

(yyyy/mm)

49. Employer's name

To:
51. City

50. Street Address, incl. Apt. No.
53. State

54. Postal/Zip code

52. Colonia/Neighborhood
56. Telephone number

55. Country

Ext.
57. Occupation (attach separate sheet if necessary).
Previous Employer name and address if current employer is less than five years (attach separate sheet if necessary).
58.

(yyyy/mm)

From:

(yyyy/mm)

59. Employer's name

To:

60. Street Address, incl. Apt. No.

62. Colonia/Neighborhood

61. City

63. State

64. Postal/Zip code

65. Country

SECTION D - ADDITIONAL INFORMATION

66.

No

Yes

If yes, have you ever received a waiver of inadmissibility to the U.S. from the CBP (former USINS)?

No

Yes

Have you ever been found in violation of customs or immigration laws?

No

Yes

Have you ever been convicted of an offense in any country?
What country were you convicted in?

If you have answered YES, please give details;

SECTION E - CERTIFICATION
67.

I certify that all information given on this application, and in support of this application, was provided voluntarily and is true and complete. I understand that any information on
this application, including any supporting documentation, background information, and biometric data may be shared among Customs and Immigration authorities in both Mexico
and the U.S. and among law enforcement and other government agencies in accordance with applicable laws. I certify that I have read, understood, and agree to abide by all
conditions required for use of the FAST program, including all instructions and notices accompanying this application.

Applicant

Name (print)

Date (yyyy/mm/dd)

Signature

U.S. PRIVACY ACT STATEMENT
The authority to collect the information on this application, any supporting documentation, fingerprints, and other requested information is contained in Titles 8 and 19 of the U.S.
Code and corresponding regulations. Furnishing the information on this form is voluntary; however, failure to provide all the requested information may result in the delay of a final
decision or denial of your application. The information collected will be used to make a determination on your application. It may also be provided to other government agencies
(Federal, state, local, and/or foreign) as permitted under the Privacy Act of 1974, 5 U.S.C. § 552a (2002), and other applicable law. All applicants are subject to a check of criminal
information databases and other immigration and customs databases in order to determine eligibility for this program.
Please mail or take your completed application along with fee to the nearest U.S./Mexico FAST Enrollment Center. Locations and addresses of U.S./Mexico FAST Enrollment
Centers can be found at www.FASTDRIVER.gov

SECTION F - FEE PAYMENT (non-refundable)

69. The fee for an applicant to the FAST program is $50.00 US only
All credit card fees will be processed as U.S. funds
Visa
I am enclosing a certified check or money order payment
Discover

MasterCard

Card holder's name (please print)

American Express

Once an application has been processed, absolutely no refunds will be granted. No exceptions.
(yyyy/mm)
Card no.
Expiration
Date

Card holder's signature

CBP Form 823F (07/10)(Back)