Criminal Record Request Form

Personal Information

Sur Name

First Name

Second Name

Maiden Name

Other Given Name

Place Of Birth

Date Of Entry (If not born in Canada)

Date Of Birth

Sex

Phone # (Mobile)

Email Address

Address Information

Street Number

Street Name

Apt/Unit

City/Town

Province/State

Postal Code/ZIP Code

Have You Lived At Your Current Address For 5 Or More Years?

Yes No

Identification

You are to provide two pieces of valid government-issued ID (Any government).

Do You Have A Valid Driver's License?

Yes No

Passport-Type Photo

Please upload a selfie passport-type photo. The photo should be shoulder to shoulder and from just above the head to just below the armpit line.

Upload Photo

Physical Attributes

Height

Use feet and inches

Weight

Use pounds

Eye Color

Hair Color

Reason for Application

Reason

Criminal History

Have You Ever Been Convicted Of A Criminal Offence For Which A Pardon Has Not Been Issued In Canada?

Yes No

Criminal Record Request Form

Personal Information

Address Information

Previous Address #1

Previous Address #2

Identification

Passport-Type Photo

Physical Attributes

Reason for Application

Criminal History