SF 86 PACKET INSTRUCTIONS/CHECKLIST

PLEASE READ THESE INSTRUCTIONS AS WELL AS THE INSTRUCTIONS ON THE SF 86
AS A MEANS TO CLARIFY THE INFORMATION ASKED FOR. CHECK THE BOXES AS YOU
COMPLETE THE FORM TO INSURE THAT YOU HAVE ANSWERED THE QUESTIONS TO THE
BEST OF YOUR ABILITY. IF THE FORMS IS NOT FILLED OUT CORRECTLY, IT WILL
DELAY THE PROCESSING TIME.

> IF THIS IS A PERIODIC REINVESTIGATION FOR A CURRENT CLEARANCE, PLEASE
> ASK YOUR SUPERVISOR TO PROVIDE AN ACCOUNTING CODE FOR PART A.

+--------------------+--------------------------------------------+---+
| 1\. FULL NAME      | Last, First, Middle (***full*** middle     |   |
|                    | name ***at birth*** -- no maiden or former |   |
|                    | married names) If no middle name, put      |   |
|                    | "NMN" or "NONE"                            |   |
+--------------------+--------------------------------------------+---+
| 2\. DATE OF BIRTH  | Self Explanatory                           |   |
+--------------------+--------------------------------------------+---+
| 3\. PLACE OF BIRTH | Self Explanatory . List City and Country   |   |
|                    | if born outside the US                     |   |
+--------------------+--------------------------------------------+---+
| 4.  SOCIAL         | Self Explanatory                           |   |
|     SECURITY       |                                            |   |
|                    |                                            |   |
| > NUMBER           |                                            |   |
+--------------------+--------------------------------------------+---+
| 5\. OTHER NAMES    | Include maiden name, former married names, |   |
| USED               | aliases and ***dates used***.              |   |
+--------------------+--------------------------------------------+---+
| 6.  OTHER          | Self Explanatory                           |   |
|     IDENTIFYING    |                                            |   |
|                    |                                            |   |
| > INFORMATION      |                                            |   |
+--------------------+--------------------------------------------+---+
| 7\. TELEPHONE      | Self Explanatory                           |   |
|                    |                                            |   |
| NUMBERS            |                                            |   |
+--------------------+--------------------------------------------+---+
| 8\. a. CITIZENSHIP | Country of Citizenship. Mark the           |   |
|                    | appropriate box and follow the             |   |
|                    | instructions                               |   |
+--------------------+--------------------------------------------+---+
| b\. MOTHER'S       | First and Last name                        |   |
| MAIDEN             |                                            |   |
|                    |                                            |   |
| > NAME             |                                            |   |
+--------------------+--------------------------------------------+---+
| c\. US CITIZENSHIP | If not born in the US, provide information |   |
|                    | about proofs of your citizenship           |   |
+--------------------+--------------------------------------------+---+
| d\. DUAL           | Past or present. Name other country of     |   |
| CITIZENSHIP        | citizenship                                |   |
+--------------------+--------------------------------------------+---+
| e\. ALIEN          | City, State, Date, Registration Number,    |   |
|                    | Country                                    |   |
+--------------------+--------------------------------------------+---+
| 9\. WHERE YOU HAVE | Provide complete street address for all    |   |
|                    | locations. If in travel.                   |   |
| > LIVED            |                                            |   |
|                    | list city, state and country with the      |   |
|                    | name, address and telephone number of      |   |
|                    | someone who can verify that information.   |   |
|                    | ***LEAVE NO GAPS IN TIME***. Follow the    |   |
|                    | instructions carefully. Use SF86A,         |   |
|                    | Continuation Sheet, for additional         |   |
|                    | addresses. ***Go back 10 years***.         |   |
+--------------------+--------------------------------------------+---+
| 10. WHERE YOU WENT | Self Explanatory. Go back 10 years.        |   |
|                    |                                            |   |
| > TO SCHOOL        |                                            |   |
+--------------------+--------------------------------------------+---+
| 11.YOUR EMPLOYMENT | Information must be current and match      |   |
|                    | those on your SF171 or resume. Follow the  |   |
| > ACTIVITIES       | instructions. ***Go back 10 years***. .    |   |
|                    | ***LEAVE NO GAPS IN TIME.*** If you were   |   |
|                    | unemployed, or self-employed, list the     |   |
|                    | dates and the name, address and telephone  |   |
|                    | number of someone who can verify that you  |   |
|                    | were unemployed or self-employed. List     |   |
|                    | supervisor's name                          |   |
+--------------------+--------------------------------------------+---+
| 12\. PEOPLE WHO    | Provide name, years known, ***street***    |   |
| KNOW               | address and phone numbers. These people    |   |
|                    | must live in the US and ***not*** be       |   |
| > YOU WELL         | relatives or former spouses.               |   |
+--------------------+--------------------------------------------+---+
| 13\. YOUR SPOUSE   | Self Explanatory                           |   |
+--------------------+--------------------------------------------+---+
| 14. YOUR RELATIVES | Self Explanatory                           |   |
|                    |                                            |   |
| > AND ASSOCIATES   |                                            |   |
+--------------------+--------------------------------------------+---+
| 15. CITIZENSHIP OF | Self Explanatory                           |   |
|                    |                                            |   |
| > YOUR RELATIVES   |                                            |   |
| >                  |                                            |   |
| > AND ASSOCIATES   |                                            |   |
+--------------------+--------------------------------------------+---+
| 16. YOUR MILITARY  | Be sure that all periods of service are    |   |
|                    | properly coded, dates are complete,        |   |
| > HISTORY          | Service/Certificate numbers are shown for  |   |
|                    | each period, O or E are marked indicating  |   |
|                    | officer or enlisted.                       |   |
+--------------------+--------------------------------------------+---+
| 17\. YOUR FOREIGN  | Self Explanatory.                          |   |
|                    |                                            |   |
| > ACTIVITIES       |                                            |   |
+--------------------+--------------------------------------------+---+
| 18. FOREIGN        | Self Explanatory. ***Last 10 years***      |   |
|                    |                                            |   |
| > COUNTRIES        |                                            |   |
| > VISITED          |                                            |   |
+--------------------+--------------------------------------------+---+
| 19\. MILITARY      | Provide information for the last 10 years. |   |
| RECORD             |                                            |   |
+--------------------+--------------------------------------------+---+
| 20\. SELECTIVE     | Self Explanatory.                          |   |
| SERVICE            |                                            |   |
|                    |                                            |   |
| RECORD             |                                            |   |
+--------------------+--------------------------------------------+---+
| 21\. MEDICAL       | Self Explanatory. Make sure dates are      |   |
| RECORD             | complete                                   |   |
+--------------------+--------------------------------------------+---+
| 22\. EMPLOYMENT    | Provide information for the last 10 years, |   |
|                    | not the last 15.                           |   |
| RECORD             |                                            |   |
+--------------------+--------------------------------------------+---+
| 23\. YOUR POLICE   | Self Explanatory. Make sure dates are      |   |
|                    | complete.                                  |   |
| RECORD             |                                            |   |
+--------------------+--------------------------------------------+---+
| 24\. ILLEGAL DRUGS | Self Explanatory. Make sure dates are      |   |
|                    | complete                                   |   |
+--------------------+--------------------------------------------+---+
| 25\. YOUR USE OF   | Self Explanatory. ***Go back 10 years.***  |   |
|                    |                                            |   |
| ALCOHOL            |                                            |   |
+--------------------+--------------------------------------------+---+
| 26\. YOUR          | Self Explanatory. Make sure dates are      |   |
|                    | complete                                   |   |
| INVESTIGATIONS     |                                            |   |
|                    |                                            |   |
| RECORD             |                                            |   |
+--------------------+--------------------------------------------+---+
| 27\. YOUR          | Self Explanatory. Provide information for  |   |
| FINANCIAL          | the ***last 10 years***,                   |   |
|                    |                                            |   |
| 28. RECORD         |                                            |   |
+--------------------+--------------------------------------------+---+
| 29. PUBLIC RECORD  | Self Explanatory. ***Go back 10 years***.  |   |
|                    |                                            |   |
| CIVIL COURT        |                                            |   |
|                    |                                            |   |
| ACTIONS            |                                            |   |
+--------------------+--------------------------------------------+---+
| 30\. YOUR          | Self explanatory. Provide information for  |   |
| ASSOCIATION        | the ***last 10 years***,                   |   |
|                    |                                            |   |
| RECORD             |                                            |   |
+--------------------+--------------------------------------------+---+
| CERTIFICATION (P   | ***Signed*** and ***dated*** in ink. Full  |   |
| 9)                 | first, Middle, Last name.                  |   |
+--------------------+--------------------------------------------+---+
| AUTHORIZATION FOR  | ***Signed*** and ***dated*** in ink. Full  |   |
| RELEASE OF         | first, Middle, Last name                   |   |
| INFORMATION (P10)  |                                            |   |
+--------------------+--------------------------------------------+---+
| CD 79 REQUEST FOR  | ***This form must be filled out and signed |   |
| SECURITY CLEARANCE | by your supervisor.***                     |   |
+--------------------+--------------------------------------------+---+
| FAIR CREDIT        | Sign and date.                             |   |
| REPORTING ACT OF   |                                            |   |
| 1970, AS AMENDED   |                                            |   |
+--------------------+--------------------------------------------+---+
| SF87 FINGERPRINT   | Fill in the blanks. Your local police      |   |
| CHARTS (2)         | department will take your fingerprints if  |   |
|                    | no one else is available. Please submit    |   |
|                    | both cards.                                |   |
+--------------------+--------------------------------------------+---+
| SF 312 CLASSIFIED  | Read it. Fill in the information under     |   |
| INFORMATION        | Item 11. Have it witnessed. ***LEAVE THE   |   |
| NONDISCLOSURE      | ACCEPTANCE BLOCK BLANK. DO NOT SIGN*** THE |   |
| AGREEMENT          | "SECURITY DEBRIEFING ACKNOWLEDGEMENT."     |   |
+--------------------+--------------------------------------------+---+

**All completed and signed forms must be mailed to**: Department of
Commerce

Office of Security

Eastern Region

Norfolk Federal Building

200 Granby Street, Room 407

Norfolk, VA. 23510

Attention: Carroll Ward