AMEDDApplicantWorksheet-July2012-3.doc

While traveling to or in this country were you

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While traveling to or in this country, were you involved in any encounter with the police? While traveling to or in this country, were you contacted by, or in contact with any person known or suspected of being involved or associated with foreign intelligence, terrorist, security, or military organizations? While traveling to, or in this country, were you involved in any counter intelligence or security issues not reported? While traveling to or in this country, were you contacted by, or in contact with anyone exhibiting excessive knowledge of or undue interest in you or your job? While traveling to or in this country, were you contacted by, or in contact with anyone attempting to obtain classified information or unclassified, sensitive information? While traveling to, or in this country, were you threatened, coerced, or pressured in any way to cooperate with a foreign government official or foreign intelligence or security service? Include question number and explain all ‘YES’ answers that apply: 41
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AWARD INFORMATION List military awards received. Do not list theater or service medals. Award: Award: Award: Award: Award: Award: Award: Award: Award: Award: GOVERNMENT AND MILITARY Complete all questions. If additional information is required for ‘YES’ answers given, the question requiring additional information will be specified. Refer to the end of the Government and Military section for further information needed for all other ‘YES’ answers provided. Y/N 1. Have you EVER served in the U.S. Military? 2. Have you EVER served, as a civilian or military member in a foreign country's military, intelligence, diplomatic, security forces, militia, other defense force, or government agency? 3. Have you EVER received a discharge that was not honorable? 4. In the last 7 years, have you been subject to court martial or other disciplinary procedure under the Uniform Code of Military Justice (UCMJ), such as Article 15, Captain's mast, Article 135 Court of Inquiry, etc? Date of the court martial or other disciplinary procedure (dd-MMM-yyyy): Description of the Uniform Code of Military Justice (UCMJ) offenses(s) for which you were charged: Description of the Uniform Code of Military Justice (UCMJ) offenses(s) for which you were charged: Court or Convening Authority: City State Country Description of the final outcome of the disciplinary procedure 5. Are you now or have you ever been a deserter from any branch of the armed forces of the United States? 6. Have you ever been employed by the United States Government? 7. Are you now drawing, or do you have an application pending, or approval for: retired pay, disability allowance, severance pay, or pension from any agency of the government of the United States? 8. Are you now or have you ever been a conscientious objector? (That is, do you have, or have you ever had, a firm, fixed, and sincere objection to participation in war in any form or to the bearing of arms because of religious belief or training?) 9.
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