U.S. Customs and Border Protection FAST Commercial Driver Application - MX
Please type or print
1a. (Check one box only) First time applicant Renewal Replacement
DEPARTMENT OF HOMELAND SECURITY
Approved OMB No. 1651-0121 Exp. 10-31-2010
1b. Border crossings most frequently used (Example, Laredo)
If renewal or replacement, current FAST Card No:
SECTION A - PERSONAL INFORMATION
2. Last/Paternal Name 2a. Maternal name
3. First name 5. Other names used (e.g., maiden name, former name) Nickname
4. Middle name (in full) 6. Gender Male Female State
4a. Suffix 7. Date of birth (yyyy/mm/dd)
8.
City
Country
Place of birth
9. Citizenship (Check all that apply.) Canadian citizen U.S. citizen Mexican citizen Other (Must Specify) 11. Proof of citizenship/residency/immigration status (Attach copies) U.S. Alien Registration No. Passport No. Country of Issuance Other Type of document No. (Expiration Date) (yyyy/mm/dd) Drivers license No. (Attach Copy) State and Country of Issuance (Expiration Date) (yyyy/mm/dd) 15. Colonia/Neighborhood (Expiration Date) (yyyy/mm/dd) or Border Crossing Card No. Birth Certificate No. 10. Residence Canada United States Mexico
12. Current address (yyyy/mm) 13. Street Address As of what date? 16. Country 17. State
SECTION B - ADDRESS HISTORY FOR THE LAST 5 YEARS
Apt. No.
14. City
18. Postal/Zip Code
19. Home telephone
20. Business telephone/Cell phone number Ext.
Mailing address if different from residential address 21. Street Address
Apt. No. 25. State
22. City 26. Postal/Zip Code
23. Colonia/Neighborhood
24. Country
Previous residential addresses if current residence is less than five years (address history continued on page 4). 27. From: 30. Colonia/Neighborhood 34. From: 37. Colonia/Neighborhood 41. From: 44. Colonia/Neighborhood (yyyy/mm) To: 45. Country 46. State 47. Postal/Zip Code (yyyy/mm) (yyyy/mm) To: 38. Country 42. Street Address 39. State Apt. No. 40. Postal/Zip Code 43. City (yyyy/mm) (yyyy/mm) To: 31. Country 35. Street Address 32. State Apt. No. 33. Postal/Zip Code 36. City (yyyy/mm) 28. Street Address Apt. No. 29. City
Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0121. The estimated average time to complete this application is 30 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.
CBP Form 823F (06/09)
48. Current employer (yyyy/mm) From:
SECTION C - EMPLOYMENT HISTORY FOR THE LAST 5 YEARS
(yyyy/mm) To: 51. City 54. Postal/Zip code 55. Country 52. Colonia/Neighborhood 56. Telephone number Ext. 49. Employer's name
50. Street Address, incl. Apt. No. 53. State
57. Occupation (attach separate sheet if necessary). Previous Employer name and address if current employer is less than five years (attach separate sheet if necessary). 58. From: 60. Street Address, incl. Apt. No. (yyyy/mm) To: 61. City 62. Colonia/Neighborhood 63. State 64. Postal/Zip code 65. Country (yyyy/mm) 59. Employer's name
66.
SECTION D - ADDITIONAL INFORMATION
Have you ever been convicted of an offense in any country? What country were you convicted in? If yes, have you ever received a waiver of inadmissibility to the U.S. from the CBP (former USINS)? Have you ever been found in violation of customs or immigration laws? If you have answered YES, please give details; No No Yes Yes No Yes
SECTION E - CERTIFICATION
67. I certify that all information given on this application, and in support of this application, was provided voluntarily and is true and complete. I understand that any information on this application, including any supporting documentation, background information, and biometric data may be shared among Customs and Immigration authorities in both Mexico and the U.S. and among law enforcement and other government agencies in accordance with applicable laws. I certify that I have read, understood, and agree to abide by all conditions required for use of the FAST program, including all instructions and notices accompanying this application.
Applicant
Name (print)
Signature
Date (yyyy/mm/dd)
U.S. PRIVACY ACT STATEMENT
The authority to collect the information on this application, any supporting documentation, fingerprints, and other requested information is contained in Titles 8 and 19 of the U.S. Code and corresponding regulations. Furnishing the information on this form is voluntary; however, failure to provide all the requested information may result in the delay of a final decision or denial of your application. The information collected will be used to make a determination on your application. It may also be provided to other government agencies (Federal, state, local, and/or foreign) as permitted under the Privacy Act of 1974, 5 U.S.C. ยง 552a (2002), and other applicable law. All applicants are subject to a check of criminal information databases and other immigration and customs databases in order to determine eligibility for this program.
Send your Completed form and photocopies of the required documents to: FAST Commercial Driver Program Customs & Border Protection Box 371124 Pittsburgh, PA 15251-7124 For Expedited delivery service, please send to: Customs and Border Protection Attn: 371124 500 Ross St. 154-0640 Pittsburgh, PA 15250
69. The fee for an applicant to the FAST program is $50.00 US only All credit card fees will be processed as U.S. funds Visa I am enclosing a certified check or money order payment Discover
SECTION F - FEE PAYMENT (non-refundable)
MasterCard American Express
Card holder's name (please print)
Once an application has been processed, absolutely no refunds will be granted. No exceptions. (yyyy/mm) Card no. Expiration Date
Card holder's signature
CBP Form 823F (06/09)(Back)