Military Clearance Signature Verification Form
Please complete all sections below to verify the applicant's signature for military clearance purposes. Do not include sensitive identifiers. All information will be used solely for signature verification.
Applicant Full Name
*
First Name
Last Name
Applicant Contact Email
*
example@example.com
Applicant Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Branch/Unit
*
Clearance Request Type
*
Please Select
Top Secret
Secret
Confidential
Other
Document/Reference Number (Internal Use Only)
*
Verification Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature Specimen (Draw or Upload)
*
Verifier Name and Title
*
Signature Verification Status / Notes
Submit Verification
Submit Verification
Should be Empty: