Questionnaire For National Security Positions - Free Download
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Questionnaire For National Security Positions
Questionnaire For National Security Positions
Depending upon the purpose of your investigation, the U.S. Government is
authorized to ask for this information under Executive Orders 10450, 10865,
12333, and 12968; sections 3301, 3302, and 9101 of title 5, United States
Code (U.S.C.); sections 2165 and 2201 of title 42, U.S.C.; chapter 23 of title
50, U.S.C.; and parts 2, 5, 731, 732, and 736 of title 5, Code of Federal
Regulations (CFR).
Your Social Security Number (SSN) is needed to identify records unique to
you. Although disclosure of your SSN is not mandatory, failure to disclose
your SSN may prevent or delay the processing of your background
investigation. The authority for soliciting and verifying your SSN is Executive
Order 9397.
This form will be used by the United States (U.S.) Government in conducting
background investigations, reinvestigations, and continuous evaluations of
persons under consideration for, or retention of, national security positions as
defined in 5 CFR 732, and for individuals requiring eligibility for access to
classified information under Executive Order 12968. This form may also be
used by agencies in determining whether a subject performing work for, or on
behalf of, the Government under a contract should be deemed eligible for
logical or physical access when the nature of the work to be performed is
sensitive and could bring about an adverse effect on the national security .
This form is a permanent document that may be used as the basis for future
investigations, eligibility determinations for access to classified information, or
to hold a sensitive position, suitability or fitness for Federal employment,
fitness for contract employment, or eligibility for physical and logical access to
federally controlled facilities or information systems. Your responses to this
form may be compared with your responses to previous SF-86
questionnaires.
Providing this information is voluntary. If you do not provide each item of
requested information, however, we will not be able to complete your
investigation, which will adversely affect your eligibility for a national security
position, eligibility for access to classified information, or logical or physical
access. It is imperative that the information provided be true and accurate, to
the best of your knowledge. Any information that you provide is evaluated on
the basis of its currency, seriousness, relevance to the position and duties,
and consistency with all other information about you. Withholding,
misrepresenting, or falsifying information may affect your eligibility for access
to classified information, eligibility for a sensitive position, or your ability to
obtain or retain Federal or contract employment. In addition, withholding,
misrepresenting, or falsifying information may affect your eligibility for
physical and logical access to federally controlled facilities or information
systems. Withholding, misrepresenting, or falsifying information may also
negatively affect your employment prospects and job status, and the potential
consequences include, but are not limited to, removal, debarment from
Federal service, loss of eligibility for access to classified information, or
prosecution.
Purpose of this Form
Authority to Request this Information
Follow instructions completely or your form will be unable to be processed. If
you have any questions, contact the office that provided you the form.
All questions on this form must be answered completely and truthfully in
order that the Government may make the determinations described below on
a complete record. Penalties for inaccurate or false statements are discussed
below. If you are a current civilian employee of the federal government:
failure to answer any questions completely and truthfully could result in an
adverse personnel action against you, including loss of employment; with
respect to Sections 23, 27, and 29, however, neither your truthful responses
nor information derived from those responses will be used as evidence
against you in a subsequent criminal proceeding.
The investigation conducted on the basis of information provided on this form
may be selected for studies and analyses in support of evaluating and
improving the effectiveness and efficiency of the investigative and
adjudicative methodologies. All study results released to the general public
will delete personal identifiers such as name, social security number, and
date and place of birth.
Background investigations for national security positions are conducted to
gather information to determine whether you are reliable, trustworthy, of good
conduct and character, and loyal to the U.S. The information that you provide
on this form may be confirmed during the investigation. The investigation may
extend beyond the time covered by this form, when necessary to resolve
issues. Your current employer may be contacted as part of the investigation,
although you may have previously indicated on applications or other forms
that you do not want your current employer to be contacted. If you have a
security freeze on your consumer or credit report file, then we may not be
able to complete your investigation, which can adversely affect your eligibility
for a national security position. To avoid such delays, you should request that
the consumer reporting agencies lift the freeze in these instances.
The Investigative Process
In addition to the questions on this form, inquiry also is made about your
adherence to security requirements, honesty and integrity, vulnerability to
exploitation or coercion, falsification, misrepresentation, and any other
behavior, activities, or associations that tend to demonstrate a person is not
reliable, trustworthy, or loyal. Federal agency records checks may be
conducted on your spouse, cohabitant(s), and immediate family members.
After an eligibility determination has been completed, you also may be
subject to continuous evaluation, which may include periodic reinvestigations,
to determine whether retention in your position is clearly consistent with the
interests of national security.
For the interview, you will be required to provide photo identification, such as
a valid state driver's license. You may be required to provide other documents
to verify your identity, as instructed by your investigator. These documents
may include certification of any legal name change, Social Security card,
passport, and/or your birth certificate. You may also be asked to provide
documents regarding information that you provide on this form, or about other
matters requiring specific attention. These matters include (a) alien
registration or naturalization documents; (b) delinquent loans or taxes,
bankruptcies, judgments, liens, or other financial obligations; (c) agreements
involving child custody or support, alimony, or property settlements; (d)
arrests, convictions, probation, and/or parole; or (e) other matters described
in court records.
Some investigations will include an interview with you as a routine part of the
investigative process. The investigator may ask you to explain your answers
to any question on this form. This provides you the opportunity to update,
clarify, and explain information on your form more completely, which often
assists in completing your investigation. It is imperative that the interview be
conducted immediately after you are contacted. Postponements will delay the
processing of your investigation, and declining to be interviewed may result in
your investigation being delayed or canceled.
Your Personal Interview
Instructions for Completing this Form
2.
3.
1. Follow the instructions, provided to you by the office that gave you this
form and any other clarifying instructions provided by that office to assist
you with completion of this form. You must sign and date, in ink, the
original and each copy you submit. You should retain a copy of the
completed form for your records.
Type or legibly print your answers in ink. If the form is not legible, it will
not be accepted. You may also be asked to submit your form using the
approved electronic format.
All questions on this form must be answered. If no response is
necessary or applicable, indicate this on the form with "N/A," unless
otherwise noted.
Any changes that you make to this form, after you sign it, must be
initialed and dated by you. Under extremely limited circumstances,
agencies may modify your response(s) with your consent.
4.
5. You must use the Location codes (abbreviations), immediately following
the Privacy Act Routine Uses, when you fill out this form. Do not
abbreviate the names of cities or foreign countries.
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Form approved:
OMB No. 3206 0005
6. Place of birth requires Country entry, even if in the U.S.
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