Where You Have Lived

List the places where you have lived beginning with your present residence and working back 5 years.

Residences for the entire period must be accounted for without breaks.

• Indicate the actual physical location of your residence, not a Post Office box or a permanent residence when you were not physically located there.
• If you split your time between one or more residences during a time period, you must list all residences.
• Do not list residences before your 18th birthday unless to provide a minimum of 2 years residence history.

• Address 1:

  Remove
  Provide street address

  This address is

  • In the U.S.
  • Outside the U.S.
  • APO/FPO/DPO

  Street address

  Apt, suite, building, floor, etc.(Optional)

  City

  State

  Zip

  Street address

  Apt, suite, building, floor, etc.(Optional)

  City

  Country

  Address

  Select APO, FPO, DPO

  • APO
  • FPO
  • DPO

  APO/FPO/DPO State Code

  Zip Code

  Provide dates of residence

  You are not required to list temporary locations of less than 90 days that did not serve as your permanent or mailing address.

  From date

  Month

  Day

  Year

  Estimated

  To date

  Month

  Day

  Year

  Estimated

  or

  Present

  Is/was this residence

  • Owned by you
  • Rented or leased by you
  • Military housing
  • Other

  Add a person that knows you

  For any address in the last 3 years, provide a person who knew you at the address, and who preferably still lives in that area. Do not list people who knew you well for residences completely outside this 3-year period, and do not list your spouse, cohabitant or other relatives as the verifier for periods of residence.

  Provide the full name

  First name

  Initial only

  Middle name

  No middle name

  Initial only

  Last name

  Initial only

  Suffix (optional)

  Jr Sr I II III IV V VII IX X Other

  Provide date of last contact

  Month

  Day

  Year

  Estimated

  Provide you relationship to this person (check all that apply)

  • Neighbor
  • Friend
  • Landlord
  • Business Associate
  • Other

  Their contact information

  Provide the following information for this person.

  Provide evening phone number for this person

  Phone number

  Extension

  Phone type Cell Home Work

  • or
  • I don't know

  This is an international or DSN phone number

  Best time to call

  • Day
  • Night
  • Both

  Provide daytime phone number for this person

  Phone number

  Extension

  Phone type Cell Home Work

  • or
  • I don't know

  This is an international or DSN phone number

  Best time to call

  • Day
  • Night
  • Both

  Provide mobile/cell phone number for this person

  Phone number

  Extension

  Phone type Cell Home Work

  • or
  • I don't know

  This is an international or DSN phone number

  Best time to call

  • Day
  • Night
  • Both

  Provide email address for this person

  or

  I don't know

  Provide street address for this person

  This address is

  • In the U.S.
  • Outside the U.S.
  • APO/FPO/DPO

  Street address

  Apt, suite, building, floor, etc.(Optional)

  City

  State

  Zip

  Street address

  Apt, suite, building, floor, etc.(Optional)

  City

  Country

  Address

  Select APO, FPO, DPO

  • APO
  • FPO
  • DPO

  APO/FPO/DPO State Code

  Zip Code