Preparing For Your Federal Clearance Session:

Federal contractor is required to have employees who need access to federal data
complete and submit a federal security clearance. In order to prepare for the
completion of your clearance application, please collect the following information
listed and bring with you on your first day. If you need more space, additional
sheets of paper are acceptable.

 United States passport, if you have travelled outside the US in the last 7
years.
 All passports issued by a country other than the US.
 Spouse's or Cohabitant’s Social Security number, if applicable.

 All addresses for the last 7 years (this month 7 years ago – today):
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
 All schooling, to include High School and College Level Degrees with the
school's address and dates you attended:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

 All employment for the last 7 years, including supervisor’s full first, last
name, email or phone number and full address:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

 First and last name, address (no P.O. Boxes) and phone numbers of 7-10
individuals who are not related to you. You will need to list references who
know you well, and they cannot be used anywhere else on the form.
1. Name: ___________________ Phone Number:_____________________
  Address: __________________________________________________
2. Name: ___________________ Phone Number: _____________________
 Address: __________________________________________________
3. Name: ___________________ Phone Number: _____________________
 Address: __________________________________________________
4. Name: ___________________ Phone Number: _____________________
 Address: __________________________________________________
5. Name: ___________________ Phone Number: _____________________
 Address: __________________________________________________
6. Name: ___________________ Phone Number: _____________________
 Address: __________________________________________________
7. Name: ___________________ Phone Number: _____________________
 Address: __________________________________________________
8. Name: ___________________ Phone Number: _____________________
 Address: __________________________________________________
9. Name: ___________________ Phone Number: _____________________
 Address: __________________________________________________
10. Name: ___________________ Phone Number:
_____________________
 Address: __________________________________________________

 Gather information on applicable relatives, including Mother and Father.

Other applicable relative options are:
 Stepmother  Stepbrother
 Stepfather  Stepsister
 Foster Parent  Half-brother
 Child (including adopted/foster)  Half-sister
 Stepchild  Father-in-law (if married)
 Brother  Mother-in-law (if married)
 Sister  Guardian
 For each applicable relative, you must provide their place of birth,
date of birth, maiden or other names used, and current address (if
alive).
 If there is no contact/relationship with a relative and information is
unknown, please gather any available information and a notation can
be made.
Mother:
Name: _____________________________________________________
 Maiden name (if applicable): _____________________________
 Other names used (if applicable): __________________________
 Date of birth: _____________________________________________
 Place of birth: _____________________________________________
 Current address: ___________________________________________

Father:
Name: _____________________________________________________
 Other names used (if applicable): __________________________
 Date of birth: _____________________________________________
 Place of birth: _____________________________________________
 Current address: ___________________________________________

Other relative:
Name: _____________________________________________________
 Other names used (if applicable): __________________________
 Date of birth: _____________________________________________
 Place of birth: _____________________________________________
 Current address: ___________________________________________

Other relative:
Name: _____________________________________________________
 Other names used (if applicable): __________________________
 Date of birth: _____________________________________________
 Place of birth: _____________________________________________
 Current address: ___________________________________________
Other relative:
Name: _____________________________________________________
 Other names used (if applicable): __________________________
 Date of birth: _____________________________________________
 Place of birth: _____________________________________________
 Current address: ___________________________________________
 For any other applicable relatives, please gather information and note on a
blank piece of paper.
 Police or Court address, as well as case details for any arrests, charges, or
convictions for any offenses during the last 7 years. You can leave out
traffic fines of less than $300
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

 Information on any bankruptcies and loan/credit issues greater than 120

days delinquent, including the name of the creditor, address, and account
number. PO Boxes not accepted.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________