Filing a fingerprint card and criminal records request form with the Insurance Division

Fingerprint Cards

Oregon administrative rule requires all applicants for a license to furnish fingerprints required by the Director of the Department of Consumer and Business Services to the examination administrator who will perform the duties of obtaining electronically the fingerprints of applicants and submitting the fingerprints for Oregon or nationwide criminal history checks. The applicant shall submit the fingerprints according to the requirements and instructions of the examination administrator.

Criminal Records Request

The criminal records request form must be submitted, as well as the fingerprint information, in order for the application to be processed.
This form can be emailed to web.insagent@state.or.us, faxed to 503-378-4351 or mailed to our office.

Criminal Records Request form   (440-4862) (Returns you to forms page)