National Security Position Screening Questionnaire

National Security Position Screening Questionnaire
Please complete all sections to assist in your eligibility screening for a national security position. Your responses will be reviewed for suitability and risk assessment.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Citizenship Status
Other (please specify)
Employment History (Past 5 Years)
Have you traveled outside your country of citizenship in the past 7 years?
List any countries you have visited or resided in (other than your country of citizenship) in the past 7 years.
Do you have any close relatives or significant contacts who are citizens or residents of other countries?
Have you ever been convicted of a crime?
Have you ever been disciplined or terminated from employment for security violations, misconduct, or policy breaches?

Please indicate your agreement with the following statements regarding your suitability for a national security position:

Rows	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I have not used illegal drugs in the past 5 years.
I have not engaged in activities that could compromise national security.
I am willing to undergo a background investigation if required.

Please provide any additional information relevant to your suitability for a national security position.
Should be Empty:

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