Applicant Personal Information
Suffix
Jr.
Sr.
I
II
III
IV
V
Driver License Expiration Date
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
Month
1
2
3
4
5
6
7
8
9
10
11
12
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Time at Current Residence
Years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Months
0
1
2
3
4
5
6
7
8
9
10
11
Residence Type
Own home w/ mortgage
Own home w/o mortgage
Rent
Live with relative
Other
Marital Status
Married
Unmarried
Separated
Applicant Previous Address
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Time at Current Residence
Years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Months
0
1
2
3
4
5
6
7
8
9
10
11
Residence Type
Own home w/ mortgage
Own home w/o mortgage
Rent
Live with relative
Other
Applicant Mother's Maiden Name
Applicant Banking Information
Applicant Employment Information
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Public Assistance
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Previous Employment Information
Income Interval
Weekly
Bi-Weekly
Monthly
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Additional Income Information
Spouse/Partner Employment Information
Income Interval
Weekly
Bi-Weekly
Monthly
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Relative Employment Information
Income Interval
Weekly
Bi-Weekly
Monthly
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Military Information
Branch
Army
Air Force
Navy
Coast Guard
Marines
Paygrade
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
O-1
O-2
O-3
O-4
O-5
O-6
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Applicant Survey
General Information
Applicant Personal Information
Suffix
Jr.
Sr.
I
II
III
IV
V
Driver License Expiration Date
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
Month
1
2
3
4
5
6
7
8
9
10
11
12
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Time at Current Residence
Years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Months
0
1
2
3
4
5
6
7
8
9
10
11
Residence Type
Own home w/ mortgage
Own home w/o mortgage
Rent
Live with relative
Other
Marital Status
Married
Unmarried
Separated
Applicant Previous Address
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Time at Current Residence
Years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Months
0
1
2
3
4
5
6
7
8
9
10
11
Residence Type
Own home w/ mortgage
Own home w/o mortgage
Rent
Live with relative
Other
Applicant Mother's Maiden Name
Applicant Banking Information
Applicant Employment Information
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Public Assistance
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Previous Employment Information
Income Interval
Weekly
Bi-Weekly
Monthly
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Additional Income Information
Spouse/Partner Employment Information
Income Interval
Weekly
Bi-Weekly
Monthly
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Relative Employment Information
Income Interval
Weekly
Bi-Weekly
Monthly
Employment Status
Contract
Full Time
N/A
Part Time
Retired
Seasonal
Self-Employed
Temporary
Employment Type
Auto Worker
Clerical
Craftman
Executive / Municipal
Farmer
Fisherman
Government
Homemaker
Other
Professional
Sales/Advertisement
Semi-Skilled Labor
Skilled Labor
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Years
0
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Applicant Military Information
Branch
Army
Air Force
Navy
Coast Guard
Marines
Paygrade
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
O-1
O-2
O-3
O-4
O-5
O-6
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NS
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Applicant Survey
General Information