Electronic Processing Questionnaire
Electronic Questionnaires for Investigations Processing (e-QIP) Investigation Request #9991746 for Applicant SSN 589-98-3345
Page 1 of 24 Archival Copy
Electronic Questionnaires for Investigations Processing (e-QIP) Investigation Request #9991746 ARCHIVAL COPY - RETAIN FOR YOUR RECORDS
The information contained in this document represents data submitted by Lilly Aguiar (Applicant) for the e-QIP Investigation Request #9991746. Applicant certified the accuracy of this information at 2011-04-12 19:52:55.330. This Investigation Request contains the following documents: Page 1: Investigation Request Cover Sheet Page 2-24: Questionnaire for National Security Positions (SF86 Format) Note: To conserve paper only the first entry in multiple-entry …show more content…
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Section 9: Citizenship
Mark the box that reflects your current citizenship status and follow its instructions. Current citizenship status I am a U.S. citizen or national by birth in the U.S. or U.S. territory/commonwealth.: { x } I am a U.S. citizen or national by birth, born outside the U.S. Go to 9A: { } I am a naturalized U.S. citizen. Go to 9B or 9C: { } I am not a U.S. citizen. Go to 9D: { } U.S. Passport
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Current or most recent passport. Passport number: 044777768 Date issued Month/Day/Year: 11/22/1996 Expired? Yes: { x } No: { } Alien Registration Number Alien registration number ( Not Applicable: { x } ) :
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Item 9A: Documentation of U.S. Citizens Born Abroad [State Department Form (FS) 240, DS 1350, FS 545, etc.]
Report information, if applicable. Date form was completed Month/Day/Year: ~ / ~ / ~ Document number: Place of issuance City: State: Country:
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Item 9B: Citizenship …show more content…
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Select the most appropriate type that describes your school. School type High School: { } College/University/Military College: { x } Vocational/Technical/Trade School: { } Correspondence/Distance/Extension/Online School: { } Name of school: Miami Dade College Street address of school Street: 300 NE 2ND AVE City: Miami State: FL Country: Zip Code: 33132
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Degree/diploma received? Yes: { } No: { x }
Box NOT Checked! . Box IS Checked! .
If "Yes," identify type of degree/diploma received and date awarded. Degree/diploma (No Entry Provided)
Person Who Knows You
For schools you attended in the last 3 years, list a person who knew you at school (instructor, student, etc.). Do not list people for education periods completed more than 3 years ago. Name: Jennifer Sanchez Current address Street: 1504 NW 21ST AVE City: Gainesville State: FL Country: Zip Code: 32609 Telephone International or DSN: { } Number: Extension:
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Page 1 of 24 Archival Copy
Electronic Questionnaires for Investigations Processing (e-QIP) Investigation Request #9991746 ARCHIVAL COPY - RETAIN FOR YOUR RECORDS
The information contained in this document represents data submitted by Lilly Aguiar (Applicant) for the e-QIP Investigation Request #9991746. Applicant certified the accuracy of this information at 2011-04-12 19:52:55.330. This Investigation Request contains the following documents: Page 1: Investigation Request Cover Sheet Page 2-24: Questionnaire for National Security Positions (SF86 Format) Note: To conserve paper only the first entry in multiple-entry …show more content…
Field is blank!
Field is blank!
Box NOT Checked!
.
.
Field is blank!
.
Section 9: Citizenship
Mark the box that reflects your current citizenship status and follow its instructions. Current citizenship status I am a U.S. citizen or national by birth in the U.S. or U.S. territory/commonwealth.: { x } I am a U.S. citizen or national by birth, born outside the U.S. Go to 9A: { } I am a naturalized U.S. citizen. Go to 9B or 9C: { } I am not a U.S. citizen. Go to 9D: { } U.S. Passport
Box IS Checked! Box NOT Checked! . Box NOT Checked! . Box NOT Checked! .
.
Current or most recent passport. Passport number: 044777768 Date issued Month/Day/Year: 11/22/1996 Expired? Yes: { x } No: { } Alien Registration Number Alien registration number ( Not Applicable: { x } ) :
. . Box IS Checked! . Box NOT Checked! . Box IS Checked! .
Field is blank!
Item 9A: Documentation of U.S. Citizens Born Abroad [State Department Form (FS) 240, DS 1350, FS 545, etc.]
Report information, if applicable. Date form was completed Month/Day/Year: ~ / ~ / ~ Document number: Place of issuance City: State: Country:
Field is blank! Field is blank! Field is blank! Field is blank!
.
Item 9B: Citizenship …show more content…
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Select the most appropriate type that describes your school. School type High School: { } College/University/Military College: { x } Vocational/Technical/Trade School: { } Correspondence/Distance/Extension/Online School: { } Name of school: Miami Dade College Street address of school Street: 300 NE 2ND AVE City: Miami State: FL Country: Zip Code: 33132
Box NOT Checked! . Box IS Checked! . Box NOT Checked! . Box NOT Checked! . . . .
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Field is blank!
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Degree/diploma received? Yes: { } No: { x }
Box NOT Checked! . Box IS Checked! .
If "Yes," identify type of degree/diploma received and date awarded. Degree/diploma (No Entry Provided)
Person Who Knows You
For schools you attended in the last 3 years, list a person who knew you at school (instructor, student, etc.). Do not list people for education periods completed more than 3 years ago. Name: Jennifer Sanchez Current address Street: 1504 NW 21ST AVE City: Gainesville State: FL Country: Zip Code: 32609 Telephone International or DSN: { } Number: Extension:
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