Background Check Alias Declaration Form
Please complete the Background Check Alias Declaration Form to provide details about any alternate names or aliases you have used. Ensure all information is accurate and complete.
Full Legal Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
List all aliases or alternate names you have used
*
Reason for using alias or alternate name
Was this alias or alternate name legally changed or used informally?
*
Legally changed
Used informally
Other
List any prior names by which your records may appear
Submit Declaration
Should be Empty: