Registry Provider Application Form

All applicants to the Public Authority Registry will be required to undergo a Department of
Justice Criminal Background Investigation to determine if the applicant has ever been
convicted of certain violations of the Penal Code. Applicants who do not “clear” the DOJ
check will not be listed on the Registry. The cost for fingerprinting is the applicant’s responsibility
(the cost is approximately $55 - $85).

Note: An incomplete application will delay processing