Sample Copy(SF-86)

Sample Copy(SF-86) - Standard Form 86 Form approved O.M.B...

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Unformatted text preview: Standard Form 86 Form approved: O.M.B. No. 3206-0007 .NAT~ONAL- SgCURITY~PO$~T~ON$ ................................ : .... NSN7540.00-634.4036 " 8~-111 Case Number Give other names you used and the period of time you used them (for example: your maiden name, name[s] by a former marriage, formal name[s], alias[ca], or nickname[s~): If the other name is your maiden name, put "nee" in front of it. I am providing:this 5lank copy of the securi{y form to assist you in the completing the on-line form.. You will need addresses and phone numbers for the people that you put on the form as well as addresses for your employments and schools.. One you have obtained that information, you should go to www.opm:gov/e-qipto complete the form on-line: If you choose to Use the b~anl~ copy to write down the addresses and phone numbers, you do not need to complete the whole form and you shodId not mail it back to me. ’" I Month/DayN~ Issued State Department F.orm 240. RaP0 ~ of Birth Abroad of a Citizen of the United States Give the date the form Month/Day/Year E×planatlon was prepared and give ~ l " , , , an e~pla~all6hJf ri~e~l~d. ~, . U.S..P=~sport ,. . .- " ~- ¯ ~ Passport Number Mo~th/DayNear IsSued This may be either a current or pravloue U.S. Passport. ’. ! DUAl. CITIZENSHIP If you are (or Were) a dual citizen of the United States and anothertC°untry country, provide the nam~ of that country In th.e space to the right, ALIEN If you Er.e an allen, provide the following Information: m=~.~ v,~. I City State Date You Entered U.S, Allen Registration Number Country(lee) of Citizenship ¯ ~= .... "~= I I t Month Day" ’ Year I ntered the ’ ~ ~ . . WHE~. YOU HAV~ UVISD List the places whore you have livod, beginning with the most resent (#I) and working back 7 years. All periods must be aoo0untecl for in your list. Be sure to indioato the actual physloal location of your residence: do not use a post office box as ~n address, do not list a permanent address when you were actually living at a achool addres’s, ors. E,e sure to spocify your location as closely as possiblo: for oxample, do not list 0nly your base or ship, list your barraoke number or home po~. Yo u may omit ten~porary miliL-~ry duty locations under 90 days (list your pormanent address instead), and you should use your APO/FPO address if you lived overseas. For any ~ddr~es in the lest ,5 years, list a person who knew you at that addrese, and.who pro~erably still lives in ~hat area (do not list people for residences oornpletely outside thi~ S-year period, and do not li~t your spou’se, form~ ~pouses, or other relat.ives). Also ~or addreeses in the last five year& i~ the ~ddress is "General Delivery," a Flur~ or Star ~out~, or may be difficult to looa~e, provide directions for looating f~he reeidenoe on an a~ached continuation sheet....
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Sample Copy(SF-86) - Standard Form 86 Form approved O.M.B...

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