FD-258 Applicant Fingerprint Card

APPLICANT

LEAVE BLANK

TYPE OR PRINT ALL INFORMATION IN BLACK
NAM
FIRST NAME
MIDDLE NAME

LAST NAME

FBI

LEAVE BLANK

* See Privacy Act Notice on Back

FD-258 (Rev. 9-9-13) 1110-0046
SIGNATURE OF PERSON FINGERPRINTED

ALIASES

AKA

O
R
I

RESIDENCE OF PERSON FINGERPRINTED

CITIZENSHIP
DATE

SIGNATURE OF OFFICIAL TAKING FINGERPRINTS
YOUR NO.

EMPLOYER AND ADDRESS

FBI NO.

CTZ

RACE

OCA

HGT.

WGT.

EYES

HAIR

DOB

PLACE OF BIRTH

POB

LEAVE BLANK

FBI

ARMED FORCES NO.
REASON FINGERPRINTED

SEX

DATE OF BIRTH
Month
Day

SOCIAL SECURITY NO.

MISCELLANEOUS NO.

CLASS

MNU
SOC

REF.

MNU

1. R. THUMB

2. R. INDEX

3. R. MIDDLE

4. R. RING

5. R. LITTLE

6. L. THUMB

7. L. INDEX

8. L. MIDDLE

9. L. RING

10. L. LITTLE

LEFT FOUR FINGERS TAKEN SIMULTANEOUSLY

L. THUMB

R. THUMB

RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY

Year

FEDERAL BUREAU OF INVESTIGATION
UNITED STATES DEPARTMENT OF JUSTICE
1. LOOP

1110-0046

CJIS DIVISION/CLARKSBURG, WV 26306
CENTER
OF LOOP

APPLICANT
THIS CARD FOR USE BY:
1.

LAW ENFORCEMENT AGENCIES IN FINGERPRINTING APPLICANTS FOR LAW ENFORCEMENT POSITIONS.*

2.

OFFICIALS OF STATE AND LOCAL GOVERNMENTS FOR PURPOSES OF EMPLOYMENT, LICENSING, AND

PERMITS, AS AUTHORIZED BY STATE STATUTES AND APPROVED BY THE ATTORNEY GENERAL OF THE
UNITED STSTES. LOCAL AND COUNTY ORDINANCES, UNLESS SPECIFICALLY BASED ON
APPLICABLE STATE STATUTES DO NOT SATISFY THIS REQUIREMENT.*

DELTA

THE LINES BETWEEN CENTER OF
LOOP AND DELTA MUST SHOW

2. WHORL

3.

U.S. GOVERNMENT AGENCIES AND OTHER ENTITIES REQUIRED BY FEDERAL LAW.**

4.

OFFICIALS OF FEDERALLY CHARTERED OR INSURED BANKING INSTITUTIONS TO PROMOTE OR MAINTAIN

THE SECURITY OF THOSE INSTITUTIONS.
Please review this helpful information to aid in the successful processing of hard copy criminal and civil fingerprint submissions in order to prevent delays
or rejections. Hard copy fingerprint submissions must meet specific criteria for processing by the Federal Bureau of Investigation.
Ensure all information is typed or legibly printed using blue or black ink.
Enter data within the boundaries of the designated field or block.
Complete all required fields. (If a required field is left blank, the fingerprint card may be immediately rejected without further processing.)
• The required fields for hard copy fingerprint cards are: originating agency identifier number - date of birth - place
of birth - name - sex fingerprint impressions - any applicable state stamp - Other (race, height, weight, eye color,
hair color)
* criminal fingerprint cards also require an arrest charge and date of arrest.
* civil fingerprint cards also require a reason fingerprinted and date fingerprinted
Do not use highlighters on fingerprint cards.
Do not enter data or labels within ‘Leave Blank’ areas.
Ensure the ‘Reply Desired’ field is checked when applicable (criminal only).
Ensure fingerprint impressions are rolled completely from nail to nail.
Ensure fingerprint impressions are in the correct sequence.
Ensure notations are made for any missing fingerprint impression (i.e. amputation).
Do not use more than two retabs per fingerprint impression block.
Ensure no stray marks are within the fingerprint impression blocks.

DELTAS

Training aids can be ordered online via the Internet by accessing the FBI’s website at: fbi.gov, click on ‘Fingerprints’, then click on ‘Ordering
Fingerprint Cards & Training Aids’. Direct questions to the Identification and Investigative Services Section’s Customer Service Group at (304) 625-5590
or by e-mail at .

PRIVACY ACT STATEMENT
Authority: The FBI's acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under
28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to
Pub.L. 92-544, Presidential Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary;
however: failure to do so may affect completion or approval of your applicatiion.

THESE LINES RUNNING BETWEEN
DELTAS MUST BE CLEAR

3. A RCH

Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based
background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise
responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI's Next Generation
Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the
employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI
after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted
to or retained by NGI.
Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics
are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by
the Privacy Act of 1974 and all applicable Rountine Uses as may be published at any time in the Federal Register, including the Routine Uses
for the NGI system and the FBI's Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to: employing, governmental
or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, and other suitability
determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security
or public safety.

INSTRUCTIONS:
ARCHES HAVE NO DELTAS

* 1.

PRINTS MUST GENERALLY BE CHECKED THROUGH THE APPROPRIATE STATE IDENTIFICATION BUREAU, AND ONLY THOSE

FINGERPRINTS FOR WHICH NO DISQUALIFYING RECORD HAS BEEN FOUND LOCALLY SHOULD BE SUBMITTED FOR FBI SEARCH.

FD-258 (REV. 9-9-13)

2.

IDENTITY OF PRIVATE CONTRACTORS SHOULD BE SHOWN IN SPACE “EMPLOYER AND ADDRESS”. THE

CONTRIBUTOR IS THE NAME OF THE AGENCY SUBMITTING THE FINGERPRINT CARD TO THE FBI.
3.

FBI NUMBER, IF KNOWN, SHOULD ALWAYS BE FURNISHED IN THE APPROPRIATE SPACE.

** MISCELLANEOUS NO. - RECORD: OTHER ARMED FORCES NO. PASSPORT NO. [FP], ALIEN REGISTRATION NO.
(AR), PORT SECURITY CARD NO. (PS), SELECTIVE SERVICE NO. (SS) VETERANS’ ADMINISTRATION CLAIM NO. (VA).