Questionnaire For National Security Positions - Free Download | Page 5
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Questionnaire For National Security Positions Page 5
Questionnaire For National Security Positions
Page 2
Section 8 - U.S. Passport Information
Do you possess a U.S. passport (current or expired)
YES NO (If NO, proceed to Section 9)
Provide the following information for the most recent U.S. passport you currently possess.
Passport number
The following link will provide U.S. State Department
passport help. http://travel.state.gov/passport
Issue date Expiration date
Est.
Provide the name in which passport was first issued.
Middle name
Last name
First name
Suffix
Section 9 - Citizenship
Select the box that reflects your current citizenship status.
I am a U.S. citizen or national by birth in the U.S. or U.S. territory/commonwealth.
(Proceed to Section 10)
I am a U.S. citizen or national by birth, born to U.S. parent(s), in a foreign country.
(Complete 9.1)
I am not a U.S. citizen. (Complete 9.3)
I am a naturalized U.S. citizen. (Complete 9.2)
Provide document number for U.S. citizen born abroad.
Provide the place of issuance. (Provide City and Country if outside the United States; otherwise, provide City and State.)
Country
State
City
Provide the name in which document was issued.
Middle name
Last name
First name
Suffix
Provide the address of the court that issued the citizenship certificate.
Provide the name in which the certificate was issued.
Middle name
Last name
First name
Suffix
Were you born on a U.S. military installation
YES NO (If NO, proceed to Section 10)
Enter your Social Security Number before going to the next page
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Est.
9.1 Complete the following if you answered that you are a U.S. citizen or national by birth, born to U.S. parent(s) in a foreign country.
Provide the date the document was issued.
(Month/Day/Year)
Est.
Provide your citizenship certificate number.
Provide the date the certificate was issued. (Month/Day/Year)
Est.
Provide type of documentation of U.S. citizen born abroad.
FS240 or FS545 DS 1350 Other (Provide explanation)
(Month/Day/Year) (Month/Day/Year)
Section 7 - Your Contact Information
Provide your contact information.
Home e-mail address Work e-mail address
Home telephone number
Extension
International or DSN phone number
Night
Day
Work telephone number
Extension
International or DSN phone number
Night
Day
Mobile/Cell telephone number
Extension
International or DSN phone number
Night
Day
Provide the name of the court that issued the citizenship certificate.
State
City
Street
Zip Code
Provide the name of the base.
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