Canadian Legal Resource Centre Inc.
Ink Fingerprinting Questionnaire
Current Legal Name
First Name
Middle Name
Last Name
Name at Birth
Is your birth name same as above?
No
Yes
First Name at Birth
Middle Name at Birth
Last Name at Birth
Other Names (Alias)
Note: An alias is only relevant if it has appeared on any legal documentation.
Do You Have Any Aliases?
No
Yes
Alias #1 First Name
Alias #1 Middle Name
Alias #1 Last Name
Alias #2 First Name
Alias #2 Middle Name
Alias #2 Last Name
Alias #3 First Name
Alias #3 Middle Name
Alias #3 Last Name
Personal Details
Gender
Male
Female
Unknown
Are you sending these ink fingerprints to the USA for processing by the FBI?
No
Yes
Date of Birth
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Height in CM
or Ft'In"
Weight in KG
or Lbs
Eye Colour
BLK
BLU
BRO
GRN
GRY
ONG
PLE
PNK
RED
WHI
XXX
Hair Colour
BLD
BLK
BLN
BLU
BRO
GRN
GRY
ONG
PLE
PNK
RED
SDY
WHI
XXX
Race
Asian or Pacific Islander
Black
Indian (American Indian or Alaskan Native)
Unknown (Of Indeterminable Race)
White (Caucasian or Latino)
Citizenship
City of Birth
Country of Birth
Social Security Number
Tip: USA Social Security Number (SSN) is not Canadian Social Insurance Number (SIN). Ignore if you were never issued a USA SSN.
Contact Information
Phone Number
Email Address
Your Current Address
Suite or Apartment Number
Address
City
Province/State
Country
Postal/Zip Code
Purpose
Reason for Fingerprinting?
ADOPTION (CDN/INTERNATIONAL)
CANADIAN CITIZENSHIP
EMPLOYMENT (FEDERAL GOVT)
EMPLOYMENT (OTHER)
EMPLOYMENT (POLICE)
EMPLOYMENT (PRIVATE INDUSTRY)
EMPLOYMENT (PROVINCIAL GOVT)
NAME CHANGE
OTHER (SPECIFY REASON)
PERMANENT RESIDENT STATUS
PRIVACY ACT REQUEST 9CMP-PPU-030
RECORD SUSPENSION APPLICATION
VISA / BORDER CROSSING/FOREIGN TRAVEL / WORK
VOLUNTEER EMPLOYMENT
Specify Other Reason
Which countries will you be submitting your fingerprints to?
Miscellaneous Information
How did you hear about us?
Federal Employment
ORI