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Last Name
First Name
Email
Cell Phone -ex. (123) 456-7890
Date of Birth (mm/dd/yyyy)
Password
Organization
Correctional Facility
Yes, I have entered my legal name in this form. NO NICK NAMES
 
Note:
  • Use your legal first and last name.
  • We will use the information you entered when completing your clearance forms.
  • The system will not allow users to share an email when registering. The system will not allow a duplicate email to be added.
  • For passwords, only use: A-Z,a-z, 0-9,@ # $ % ^
  • Password must be at least 8 characters long and no longer than 16.
  • We do require a cell phone. Our system uses text messaging to update you on the status of your application.
  • You will receive text messages from us from time to time.