Criminal Record Check – Client Information Form Surname (Last Name) Surname at birth: Given Name(s) Former Name(s) Sex Female Male Other Date of Birth Place of Birth Email Address Phone Number Current Home Address Previous Address(es) within the last 5 Years Type of the Criminal Record Check Criminal Record Check ( CRC ) Criminal Record and Judicial Matters Check ( CRJMC ) One Hard Copy? Yes No Additional Information Reason for check Privacy Policy I agree to the Privacy Policy Submit Information Please complete this form so we can review your requirements and prepare the appropriate documents for your Criminal Record Check.This form is for information collection only. It is not an official Criminal Record Check application or consent form.
