Summary: CP491 Request for Check of Criminal History Records (05/25)

This document is a form template issued by the United States Capitol Police for initiating criminal history background checks. The form is divided into two main sections: one for applicants and one for authorized requestors. The applicant section (fields 1-18) requires collection of personal identifying information including name, address, employer, position, telephone number, date of birth, birthplace, social security number, citizenship status, and physical descriptors (gender identity, race, height, weight, eye color, and hair color). Additionally, applicants must provide any other names previously used and acknowledge they understand their information will be submitted to the Federal Bureau of Investigation for a criminal history records check to support security determinations. The applicant must also certify they are authorized to work in the United States and attest to the accuracy of provided information under penalty of perjury.

The authorized requestor section (fields 19-25) requires completion by an individual authorized to request the background check on behalf of an applicant's agency. This section collects the requestor's name, agency affiliation, position/title, telephone number, and date of request. The requestor must verify the applicant's authorization to work within the United States and compliance with relevant immigration and employment control statutes. The form also includes a section for the Badging and Credentialing Division to document when the records check was conducted, the FBI number assigned (if applicable), and identity verification documentation. Both the applicant and requestor must provide signatures and dates to validate the submitted information.