Electronic Questionnaires for Investigations Processing

Topics: ZIP code, Federal government of the United States, Social Security number Pages: 50 (10784 words) Published: April 12, 2012
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 lists displays completion instructions. The completion instructions for the first entry also applies to each additional entry unless otherwise noted.

Certified at 2011-04-12 19:52:55.330 Data Hash Code: 5faef73862fb1eebcffe2ee7f35b7fbed3c24847


Electronic Questionnaires for Investigations Processing (e-QIP) Investigation Request #9991746 for Applicant SSN 589-98-3345

Page 2 of 24 Archival Copy

Form Completion Instructions

Questionnaire for National Security Positions (SF86 Format)
OMB No. 3206-0005 Follow instructions fully or we cannot process your form. If you have any questions, contact the office that gave you the form.

Purpose of this Form
The United States (U.S.) Government conducts background investigations and reinvestigations of persons under consideration for or retention in national security positions as defined in 5 CFR 732 and for positions requiring access to classified information under Executive Order 12968. Giving us 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. Any information that you provide is evaluated on the basis of its recency, seriousness, relevance to the position and duties, and consistency with all other information about you. Withholding, misrepresenting, or falsifying information will have an impact on a security clearance, employment prospects, or job status, up to and including denial or revocation of your security clearance, or your removal and debarment from Federal Service. This form is a permanent document that may be used as the basis for future investigations, security clearance determinations, and determinations of your suitability for employment. Your responses to this form may be compared with previous security questionnaires. It is imperative that the information provided be true and accurate to the best of your knowledge.

Authority to Request this Information
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, U.S. 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. Your Social Security Number (SSN) is needed to identify your unique records. 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.

The Investigative Process
Background investigations for national security positions are conducted to gather information to show 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, even if...
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