2. First Name:*
3. Last Name:*
5. Telephone Number:*
7. Email Address:*
9. Date Requested*
   Date Requested

   (Must be 3^rd Saturday of every month)

10. Time Requested:*
    -- Select One --10:00 a.m.10:30 a.m.11:00 a.m.11:30 a.m.12:00 p.m.12:30 p.m.1:00 p.m.

    (Must be between 10:00 a.m. and 1:00 p.m.)

12. Please identify yourself from the following for which you are requesting fingerprint services:*

    1. Wheaton Resident:

    1. Employer within the City of Wheaton:
14. Street Address:
15. Business Name:
17. Apt, suite, etc. (optional):
18. Street Address:
20. Please acknowledge the below requirements:*

    1. Payment of $25.00 must be paid at the time of the appointment. Cash or checks are accepted. Checks can be payable to the City of Wheaton.
22. 1. You must bring a fingerprint card from the requesting party for this service.
24. Additional Fingerprinting Services:

    1. Seeking Employment with the City of Wheaton
    2. Selection to the Citizens Police Academy
    3. Application requirement for Citizen Ride Along
    4. Requesting to be a volunteer for the Police Department
    5. Other non-cje fingerprinting request

26. *A representative from the Wheaton Police Department will contact you to confirm your appointment.

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field