1862 (2018/06)
LIBRARY OF CONGRESS APPLICANT DATA FORM
Applicants: a completed form will include personally identifiable information (PII) and should only be sent electronically through a secure / encrypted process.
1. FULL NAME (Provide your full name: First, Middle, Last, Suffix. If you have only initials in your name, provide them and indicate “initial only.” If you do not have a
middle name, indicate “No Middle Name.” If you are “Jr.,” “Sr.,” etc., enter this under Suffix.)
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2. SOCIAL SECURITY NUMBER
3. PLACE OF BIRTH (Include city and state or country.)
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4. ARE YOU A U.S. CITIZEN?
5. DATE OF BIRTH (MM / DD / YYYY)
☐ YES
☐ NO (If “NO,” provide country of citizenship)
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6. OTHER NAMES EVER USED (For example, maiden name, nickname, etc.)
7. PHONE NUMBER (Include area code)
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8. EMAIL ADDRESS
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MAILING ADDRESS (Include street address or box number, apartment or suite number, city, state, ZIP code, and country if not U.S.)
Do any of your relatives work for the Library of Congress? (Include: father, mother, husband, wife, son, daughter,
brother, sister, uncle, aunt, first cousin, nephew, niece, father
-in-law, mother-in-law, son-in-law, daughter-in-law, brother-
-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half-brother, and half-
sister.)
If “YES,” provide relative name
(s) and relationship(s) and the Library organizational unit(s) where your relative(s) work.
☐ YES
☐ NO
INSTRUCTIONS FOR LIBRARY EMPLOYEES AND CONTRACTORS
In accordance with Library of Congress Directive (LCD)
5-920.3, use of this form by Library employees or contractors is restricted to those individuals who require it in
connection with official business. Library employees or contractors
must secure paper copies of this form in a locked environment when not in use, must not take paper
ff site, must access electronic copies of this form only through a secure, approved Library network, and must dispose of paper copies after use by
shredding or return them to the Office of Human Resources Services for shredding, pursuant to Library records management policies.
