15F06719R0000004_0007,_Atch_23_Submitting_Candidates_for_Access_to_FBI_Facilities.pdf

SUBMITTING CANDIDATES

FOR ACCESS TO

FBI FACILITIES

A GUIDE ON LIMITED BACKGROUND INVESTIGATIONS (LBIs)

AND

VISIT ACCESS REQUESTS (VARs)

FEDERAL BUREAU OF INVESTIGATION | 935 Pennsylvania Ave, NW Suite 8368, Washington, D.C. 20535

ALL REFERENCES TO LIMITED BACKGROUND INVESTIGATIONS (LBIs) ARE

CHANGED TO LIMITEDACCESS REQUIREMENTS (LAR)

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TABLE OF CONTENTS

Introduction ……………………………………………………………………………………….……………………………………..2

LBI Process Overview……………………………………………………………………………………………………….2

LIMITED BACKGROUND INVESTIGATIONS: ……………………………………………………………………………………….3

LBI Submission Instructions……………………………………………………………………………………………..3

FD-316 and FD-484 Overview…………………………………………………………………………………………..4

FD-316 In-Depth……………………………………………………………………………………………………………….5

FD-816 Overview and In-Depth…………………………………………………………………………………………6

Fingerprint Submission……………………………………………………………………………………………………..7

Hard Copy Fingerprint Instructions……………………………………………………………………………………8

LBI Applicant Instructions Document………………………………………………………………………………..9

LBI DOCUMENTATION:

FD-316………………………………………………………………………………………………………………………….…10

FD-816…………………………………………………………………………………………………………………………….11

FD-484…………………………………………………………………………………………………………………………….12

VISIT ACCESS REQUESTS………………………………………………………………………………………………………………..13

Example of a VAR…………………………………………………………………………………………………………….14

JUSTICE ENTERPRISE FILE SHARING………………………………………………………………………………………………..15

Approved File Naming Structure……………………………………………………………………………………...15

ACRONYM GUIDE…………………………………………………………………………………………………………………………..16

To the Security Point of Contact (SPOC):

This packet will walk you through the process of collecting, reviewing and submitting the necessary paperwork to process a Limited Background Investigation for personnel who do not hold an active clearance with any government agency. You are the responsible official in communicating all applicable information from the applicant to the Office of Security Operations (OSO). Please review this guide carefully.

Overview of the Process

Security Point of Contact

Send the applicant the following LBI forms:

Applicant Completes the following:

FD-816, FD-484, FD-835 or FD-835A, FD-857A, and the FD-979

Send the completed forms to the SPOC for review.

Security Point of Contact

Verify all LBI paperwork is complete. Attach the completed FD-316 and upload to your company folder on JEFS.

Office of Security Ops

Review LBI packet for any missing information

Send appointment for applicant fingerprinting

Security Point of Contact

Provide applicant with fingerprint appointment time and location.

Office of Security Ops

Fingerprint Applicant on Appointment date

Add fingerprint results to packet and process

Office of Security Ops

Upon completion of investigation, send the approval/denial decision to the SPOC.

Security Point of Contact

Forward the decision notice to the applicant.

Applicant

If a favorable decision notice is received, the applicant may begin work on the project.

FD-816

FD-484

FD-835 or FD-835A

FD-857A

FD-979

This is the LBI instructional document that can be provided to your applicant.

The preferred method of distribution is electronic.

If you choose to provide a hard copy packet to your applicant, please ensure that you print off the attached files for them.

All LBI submissions will now be uploaded to the Justice Enterprise File Sharing (JEFS) portal as explained on page 15 of this document.

On the following pages you will find a breakdown of each document in the LBI packet, its purpose, and how to properly complete it.

Remember, it is your responsibility as the applicant’s SPOC to ensure that the packet is fully completed.

Any packets with missing and/or incomplete information will be REJECTED!!!!

SUBMITTING LBI PAPERWORK

LBI paperwork should be submitted as a SINGLE PDF file to your company folder located on JEFS (see pg.

15). When submitting paperwork please avoid the following:

Combining multiple candidate files into a single PDF document. Each candidate file should be saved individually in the approved file name format (see page 15).

• Submitting multiple PDF documents for a single candidate. All applicable docs should be included in a single file.

* Deviations from these instructions may lead to the delay or rejection of the candidate’s application. *

FD-316

FD-484

THE LBI PACKET

The FD-316 “Access to FBI Facilities” document acts as the cover letter of the LBI packet. It identifies the applicant, their purpose for access, their FBI point of contact (this is the FBI employee who is responsible for the contractor during their time on the project), and the sponsoring FBI division.

Required fields are highlighted on the next page. The

Background Investigation Team will assist you with properly filling out this form for each project your company is assigned. Once completed the first time, the only information that will need to be modified with each new submission is the Candidate’s name. Please keep the other information consistent to facilitate processing.

The FD-484 “Privacy Act Notice For Individuals Subject To A Limited Background Investigation” document notifies the applicant that the information they provide will be used to verify their identify and to collect information regarding their background and any potential risks.

The applicant will need to read and sign this document confirming their understanding of the terms.

FD-484

FD-316 DOCUMENT REQUIREMENTS

The FD-816 “Access of Non-FBI Personnel to FBI Facilities/Systems Background Information Form” is the primary document in the LBI packet.

This form collects all the required information to perform the necessary background checks to verify an applicant’s eligibility for the project.

Please ensure that all the information is filled out according to the directions provided on the form.

COMMON ITEMS MISSING OR INCOMPLETE ON THE FD-816:

Place of Birth – This field requires (a) their City and State of birth if born in the United States or (b) their country of birth if born abroad. The common mistake here is they will list only the state of birth or simply “USA”.

Social Security Number – This field requires the applicant’s FULL social security number. The common error is the applicant will only list the last four digits of their social (ex. xxx-xx-1234) Proof of Citizenship – Anyone who was born abroad (US citizen, naturalized, or foreign national) needs to provide proof of their citizenship. This can include a certificate of birth abroad, certificate of Naturalization, U.S.

Passport, or Alien Registration card.

Additional Documentation – If an applicant responds “Yes” to any of the questions on the FD-816, they must provide additional documentation regarding their response.

o

Offenses Section – Applicant should list the offense as well as the approximate date it occurred. For multiple offenses, each offense should be listed separately.o

Foreign Travel – all foreign travel should be listed to include the country visited and approximate dates.

FD-816 DOCUMENT REQUIREMENTS

FINGERPRINTING

In addition to completing the LBI packet, each of the applicant’s must be fingerprinted. These fingerprints will be used to setup a notification on the applicant’s file at the Criminal Justice Information System (CJIS) to alert us to any encounters with law enforcement during the duration of their involvement in a project. There are two ways that fingerprinting can be completed:

Electronically Hard Copy (see page 8)

Electronic Fingerprinting

Applicants who are nearby one of the locations listed below can request an onsite fingerprint appointment. The requested date should be included in the PDF file name:

Last Name, First Name Middle Name_LBI_Site Location (Requested Fingerprint Date) - Company Name Doe, John Christian_LBI_Quantico (Oct. 31) - Ghost Busters Inc.

Once the applicant’s LBI packet has been received, you will receive a reply e-mail confirming the appointment time for the applicant’s fingerprinting slot.

Most locations provide fingerprinting services between the hours of 8:00 AM and 2:00 PM, Monday – Friday.

There may be variations to this based on the individual circumstances that routinely take place at each of the available locations. If your requested time is unavailable, you will be provided with several alternative options.

Available Fingerprinting Locations:

FBI Headquarters (Washington, D.C.) FBI Academy (Quantico) FBI Facility (Huntsville, AL)

Directions to each location may be available upon request.

Front

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OECUTTING

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OECUTTING

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HARD COPY FINGERPRINTS

Applicants who are unable to complete electronic fingerprints at one of the identified FBI locations will need to submit hard copy fingerprints on the FD-258 form shown below. This can be done at most local police stations.

FD-258 Required Fields:

Last Name / First Name Signature of Person Fingerprinted Residence of Person Fingerprinted Date & Signature of Official Employer Name and Address Reason Fingerprinted Citizenship Social Security Number Sex Race Height / Weight Eye Color Hair Color Date of Birth Place of Birth All Fingerprint

Two copies of the FD-258 should be completed and turned in with the LBI paperwork. Please ensure that the applicant is aware of the required fields on the FD-258 if they elect this option of hard copy fingerprinting.

Note:

Please use this as a last method option. Using this method will add approximately 7-10 additional business days to the processing of the application bringing the total processing time close to a full month from receipt of the fingerprint cards.

Dear Applicant, To submit your Limited Background (LBI) application for access to an FBI facility, please follow the process outlined below. Approved access to other Federal Government facilities does not waive the requirement to submit the LBI nor guarantee that access will be granted. If you possess an active security clearance, please notify your Security Point of Contact (SPOC) who will provide you with the appropriate steps to proceed.

Complete the following forms and return them to your SPOC: FD-816, FD-484, FD-835/835A, FD-857A, and the FD-979

Please Note: Additional Details are required for foreign travel and any offense history.

Proof of Citizenship is required for those born abroad (can include:

current U.S. Passport, naturalization certificate, or Certificate of Birth Abroad).

Your SPOC will send you a calendar invitation to arrive at an

FBI facility for fingerprinting.

Fingerprints may also be submitted by mail using two completed copies of the FD-258 form.*

*Note: Adds additional processing time of 7-10 days.

TRAVEL OFFENSES BIRTH ABROAD

Upon completing the fingerprinting, your application will be submitted for processing and a response should be provided within 5-10 business days. If granted approval for access, you will be issued an access badge for escorted access to your designated work area. All questions should be directed to your SPOC.

Very Respectfully, Background Investigation Team Office of Security Operations Federal Bureau of Investigation

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Important Reminder

All VARs must be submitted by (1) a Facility Security Officer (FSO) or (2) the President of the applicant’s company. It must also be submitted on company letterhead.

PASSING AN ACTIVE CLEARANCE TO THE FBI

For those companies who possess a Facility Security Clearance (FSC) and wish to submit an applicant who currently possess an active security clearance, they may provide a Visit Access Request (VAR) to have the applicant’s clearance passed over to the FBI. The instructions for completing this process are attached as shown to the right.

The benefits of passing a clearance versus submitting for a Limited

Background Investigation (LBI) include:

Reduced processing time Less paperwork needed

VARs are sent to the Clearance Passage and Subprograms Unit (CPSU) at visitaccessrequest@ic.fbi.gov The VAR is usually processed within 7 business days. Please cc LBI@ic.fbi.gov on all VAR submissions.

Fingerprinting

Although fingerprints are not required to submit a VAR and be cleared for the project, the applicant will still need to submit current fingerprints at some point to enable the notification of any law enforcement encounters.

VISIT ACCESS REQUEST (VAR) SAMPLE LETTER

IMPORTANT ELEMENTS

Company Letterhead Current Date Applicant Name Social Security # Date of Birth Place of Birth Clearance Type Origin Agency Date of Issuance Length of Visit FBI Point of Contact Signature of FSO Contact Info for FSO

If the VAR is missing even a single one of these elements, the Clearance

Passage Unit (CPSU) will not process it.

GETTING ACCESS TO JUSTICE ENTERPRISE FILE SHARING (JEFS)

In order to gain access to JEFS, you will need to complete the form listed to the right. This 5 page form contains the rules and behaviors that must be adhered to in order to receive access.

Once you have completed the form, a folder will be created for your company. This will be the repository of all your LBI submissions and will also act as the status update registry where you can see real time updates on your candidate submissions.

JEFS provides a secure end-to-end solution for submitting the LBI documents which contain sensitive Personally Identifiable Information

(PII).

LBI submissions should be submitted as a single PDF file per candidate.

The file name should be formatted as seen below.

APPROVED FILE NAMING STRUCTURE:

Last Name, First Name Middle Name_LBI_Location (Fingerprint Date)-Company

Example:

Doe, John Christian_LBI_Quantico (Oct. 31) - Ghost Busters Inc.

Work Location Options:

FBIHQ, Quantico, Redstone, Pocatello Ex: (Oct. 31)

Jan/Feb/Mar/Apr/May/June/July/Aug/Sep/Oct/Nov/Dec

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ACRONYM GUIDE

Acronym Definition CJIS Criminal Justice Information Services CPSU Clearance Passage and Sub-programs Unit GC General Contractor FBI Federal Bureau of Investigation FSO Facility Security Officer JEFS Justice Enterprise File Sharing JEH J. Edgar Hoover (usually referring to the FBI Headquarters building) LBI Limited Background Information OSO Office of Security Operations POC Point of Contact QT Quantico SecD FBI Security Division SPOC Security Point of Contact VAR Visit Access Request

Limited Background Investigation Packet

(LBI)

Federal Bureau of Investigation 2017-2018

FD-316

Revised (12-17-2009)

FEDERAL BUREAU OF INVESTIGATION

ACCESS TO FBI FACILITIES

260C-HQ-1188944-Sub- __________________

To: Security Division, FBIHQ Date: _____________________ Attention: Contractor Clearance Unit

From: _____________________________________________ Name of Division

Subject: ________________________________________________ Candidate's Name

General Information

Type of Request: G Escorted Access

Location of Access: G FBIHQ G Other FBI Facilities __________________________________ (Division/Field Office)

Reason for Access (Explanation of Duty): ______________________________________________

Frequency and Duration of Access (Dates): __________________________________________

Complete For Access To FBI Facilities

Point of Contact: ____________________________________________________________ (must be completed)

Division: _______________________________ Phone: ____________________ Room: ____________

Required Enclosures: ______FD-816 ______ (2) FD-258 ______ FD-484 ______ SF-85P (Physicians only)

Instructions: Mark the appropriate box for each check conducted and attach an explanation of any derogatory results.

Universal/Manual Indices State and Local Police NCIC/Wanted Triple I Check G Pos. G Neg. G Pos. G Neg. G Pos. G Neg. G Pos. G Neg.

Division Recommendation: _______________ Granted Access _______________ Denied Access (Attach Explanation)

E-mail Notification Sent __________________ (Date)

FD-816 (4-21-16)

ACCESS OF NON-FBI PERSONNEL TO FBI FACILITIES/SYSTEMS

BACKGROUND INFORMATION FORM

(COMPLETE ALL PORTIONS)

CERTIFICATION THAT MY ANSWERS ARE TRUE

I have read and understand each of the above questions. My statements on this form, and any attachments to this form, are true, complete, and correct to the best of my knowledge and belief and are made in good faith.

I understand that a knowing and willfully false statement on this form can be punished by fine or imprisonment or both and will be reason to deny access to all FBI facilities / projects.

Signature _____________________________________________________ Date __________________________

FULL NAME (Type or Print Legibly) OTHER NAMES (Maiden Name / Aliases)

HOME ADDRESS (Include City and State) SOCIAL SECURITY NUMBER

PHONE NUMBER (Best Contact Number)

E-MAIL ADDRESS

DATE OF BIRTH (Month / Day / Year) PLACE OF BIRTH (Include City and State)

U.S. CITIZENSHIP:

*Proof may include: Current US Passport, Certificate of Naturalization, Permanent Resident card, etc.

LOCATION NATURALIZED DATE NATURALIZED

ALIEN REGISTRATION NUMBER LOCATION REGISTERED DATE REGISTERED

PLEASE ANSWER ALL QUESTIONS – IF YOU ANSWER YES TO ANY QUESTION, PLEASE FURNISH DETAILS*

Have you ever been charged with or convicted of any felony offense? YES NO

Have you ever been charged with or convicted of a firearms or explosive offense? YES NO

Are there currently any charges pending against you for any criminal offense? YES NO

Have you ever been charged with or convicted of any offense(s) related to alcohol or drugs? YES NO

In the last 10 years have you been arrested for, charged with, or convicted for any offense(s) not listed above? YES NO

(Traffic fines under $100 may be excluded)

FOREIGN TRAVEL – PLEASE FURNISH DETAILS (LOCATIONS AND APPROXIMATE DATES) OF ALL FOREIGN TRAVEL

Have you ever lived in, or visited a foreign country?

YES NO

COMPANY NAME

COMPANY CITY, STATE

COMPANY STREET ADDRESS

SUPERVISOR NAME & PHONE NUMBER

IF

A

P P

LI

C

A B

LE

By Birth (If born abroad, please provide Certificate of Birth Abroad or see below*) Naturalization (Attach proof of Citizenship* and complete the lines below)

Other (Attach a Permanent Resident card or Employment Verification Document )

*Details may be attached on a separate page if necessary.

FD-857a (9-9-2016)

SENSITIVE INFORMATION

NONDISCLOSURE AGREEMENT

An Agreement between _________________________________________________________ and the Federal Bureau of Investigation (FBI) regarding the following activities:

1. Intending to be legally bound, I hereby accept the obligations contained in this Agreement in consideration of my being granted access to FBI controlled facilities as required to perform my duties. While I have not been granted access to sensitive information, I acknowledge that I could inadvertently become exposed to sensitive information in the course of my duties. As used in this Agreement, sensitive information is marked or unmarked information, including, but not limited to, oral communications, the disclosure of which may compromise, jeopardize or subvert any investigation. Sensitive information also includes information relating to closed investigations, the disclosure of which might compromise, jeopardize or subvert other law enforcement activities or investigations. I understand and accept that by being granted access to FBI controlled facilities, special confidence and trust shall be placed in me by the FBI.

2. I hereby acknowledge that I have received an indoctrination concerning the nature and protection of sensitive information, including the procedures to be followed in the event that I am inadvertently exposed to sensitive information, ascertaining whether other persons to whom I contemplate disclosing this information have been approved for access to it, and that I understand these procedures.

3. I have been advised that the unauthorized access, unauthorized disclosure, unauthorized retention, or negligent handling of sensitive information may cause irreparable damage to FBI investigations and that I will never divulge sensitive information to anyone unless (a) I have officially verified that the recipient has been properly authorized by the FBI to receive it; or (b) I have been given prior written notice of authorization from the FBI that such disclosure is permitted. I understand that if I am uncertain as to the sensitive nature or status of information, I am required to confirm from an authorized official that the information may be disclosed prior to disclosure of this information.

4. I have been advised that any breach of this Agreement may result in the termination of my relationship with the FBI and access to FBI controlled facilities. In addition, I have been advised that any unauthorized disclosure of information by me may constitute a violation or violations of United States criminal laws, including Title 18, United States Code, or may lead to criminal prosecution for obstruction of lawful government functions. I realize that nothing in this Agreement constitutes a waiver by the United States of the right to prosecute me for any statutory violation.

5. I understand that all sensitive information to which I may be exposed to by signing this agreement is now and will remain the property of, or in the control of the FBI unless otherwise determined by an authorized official or final ruling in a court of law. I agree that I shall return all sensitive materials which have or may come into my possession: (a) upon demand by an authorized representative of the United States Government; (b) upon discovery that the materials contain sensitive information; or (c) upon the conclusion of my relationship with the FBI, whichever occurs first.

6. I understand that these restrictions are consistent with and do not supersede, conflict with, or otherwise alter my obligations, rights, or liabilities created by Executive Order No. 12958; Section 7211 of Title 5, U.S.C.

(governing disclosures to Congress); Section 1034 of Title 10, United States Code, as amended by the Military Whistleblower Protection Act (governing disclosure to Congress by members of the military); section 2302(b)(8) of Title 5, United States Code, as amended by the Whistleblower Protection Act (governing disclosures of illegality, waste, fraud, abuse or public health or safety threats); the FBI Whistleblower Protection Act (5 U.S.C. 2303, 28 C.F.R. Part 27) (governing disclosures of illegality, waste, fraud, abuse or public health or safety threats); the Intelligence Identities Protection Act of 1982 (50 U.S.C. 421 et seq.) (governing disclosures that could expose confidential government agents); and the statutes which protect against disclosure that may compromise the national security, including Sections 641, 793, 794, 798, and 952 of Title 18, United States Code, and Section 4(b) of the Subversive Activities Act of 1950 (50 U.S.C. 783(b)). The definitions, requirements, obligations, rights, sanctions, and liabilities created by said Executive Order and listed statutes are incorporated into this agreement and are controlling. I further understand, however, that any such information that is disclosed pursuant to applicable federal law continues to be subject to this agreement for all other purposes, and disclosure to the appropriate entities provided by federal law does not constitute public disclosure or declassification, if applicable, of such information.

7. Unless and until I am released in writing by an authorized representative of the FBI, I understand that all conditions and obligations imposed upon me by this Agreement apply during the time I am granted access to FBI controlled facilities and at all times thereafter.

8. Each provision of this Agreement is severable. If a court should find any provision of this Agreement to be unenforceable, all other provisions of this Agreement shall remain in full force and effect.

9. I understand that the United States Government may seek any remedy available to it to enforce this Agreement including, but not limited to, application for a court order prohibiting disclosure of information in breach of this agreement. I hereby assign to the United States Government all royalties, remunerations, and emoluments that have resulted, will result or may result from any disclosure, publication, or revelation of sensitive information not consistent with the terms of this Agreement.

10. I have read this Agreement carefully and my questions, if any, have been answered.

Signature ________________________________________________________ Date __________________

Organization (if contractor, provide name and address):

The briefing and execution of this Agreement was witnessed by __________________________________________ (Type or Print Name)

Signature ________________________________________________________ Date ________________________

SECURITY DEBRIEFING ACKNOWLEDGMENT

I reaffirm that the provisions of the Federal criminal laws applicable to the safeguarding of sensitive information; that I have returned all sensitive information in my custody; that I will not communicate or transmit sensitive information to any unauthorized person or organization; that I will promptly report to the FBI any attempt by an unauthorized person to solicit sensitive information, and that I have received a debriefing regarding the security of sensitive information.

Signature ______________________________________________________ Date __________________

Name of Witness (Type or Print) __________________________________________________________

Signature of Witness _____________________________________________ Date __________________

FD-835 (Rev. 1-25-02)

SECURITY ACKNOWLEDGMENT FORM

Instruction: Read, date, sign and keep one of the two copies.

I hereby acknowledge by my signature that I am fully aware, and understand completely, the information provided to me during the security briefing. I also agree to adhere to the below-listed instructions:

1. I will not read or browse through computerized data, files, or any materials that may be on desks or other office furniture.

2. As a condition of my having access to an FBI facility, I will not disclose to unauthorized persons any information that may come to my attention as a result of my work at the FBI facility.

3. I will report any attempts to obtain information concerning FBI cases, operations, personnel, or facilities.

4. I will not attempt to access or venture into any space without prior permission or approval from the appropriate FBI personnel.

5. I will report any planned foreign travel or contact with foreign nationals to the FBI Security Programs Manager, the Division Security Officer and/or Contracting Officer Technical Representative.

6. I will report any security violations, whether committed by myself or others, to either the Security Programs Manager, the Division Security Officer, and/or Contracting Officer Technical Representative.

7. I will advise the Security Programs Manager, or the Division Security Officer and/or Contracting Officer Technical Representative if, while I have access to an FBI facility, I am involved in any violations of the law, have adverse contact with a police agency, or are involved in any other situation that may impact the FBI’s or my agency’s assessment of my trustworthiness.

8. I understand the possible consequences if I violate FBI security requirements.

Continued - Over

IF ISSUED A SECURITY BADGE

1. I will safeguard my task force badge and display it only while in an FBI facility. I will not otherwise use my badge to indicate my relationship with the FBI.

2. I will immediately report to the FBI Security Programs Manager, Division Security Officer, and/or Contracting Office Technical Representative if my badge is lost, stolen, or misplaced.

3. I will not attempt entry with a badge that I know has been reported as being lost, stolen, misplaced or does not belong to me

4. I will not give my badge to another person or allow another person to use my badge.

5. I will advise the FBI Security Programs Manager, Division Security Officer and/or Contract Officer Technical of the identity of any individual attempting to gain entry either illegally or attempting to circumvent FBI security policies and procedures.

6. I acknowledge the Security badge to be FBI property and will ensure its return to

FBI security when no longer needed.

7. I also understand the issuance of the Security badge does not entitle me to escort others within FBI space.

Date ____________________

Printed Signature ______________________________

Written Signature ______________________________

Address ______________________________________

Social Security Number _________________________

Company Name ________________________________

Witness: __________________________________ Position: ______________________________ (Security Officer or other designated officials)

Date: ________________________

FD-835a (1-25-02)

FOREIGN NATIONALS

SECURITY ACKNOWLEDGMENT FORM

Instruction: Read, date, sign and keep one of the two copies.

I hereby acknowledge by my signature that I am fully aware, and understand completely, the information provided to me during the security briefing. I also agree to adhere to the below-listed instructions:

1. I will not read or browse through computerized data, files, or any materials that may be on desks or other office furniture.

2. As a condition of my having access to an FBI facility, I will not disclose to unauthorized persons any information that may come to my attention as a result of my work at the FBI facility.

3. I will report any attempts to obtain information concerning FBI cases, operations, personnel, or facilities.

4. I will not attempt to access or venture into any space without prior permission or approval from the appropriate FBI personnel.

5. I will report any planned foreign travel outside the United States or contact with foreign nationals who are not US or citizens to the FBI Security Programs Manager, the Division security Officer, or my FBI point of contact.

6. I will report any security violations, whether committed by myself or others, to either the Security Programs Manager, the Division Security Officer, or my FBI point of contact.

7. I will advise the Security Programs Manager, or the Division Security Officer if, while I have access to an FBI facility, I am involved in any violations of the law, have adverse contact with a police agency, or are involved in any other situation that may impact the FBI’s or my agency’s assessment of trustworthiness.

8. I understand the possible consequences if I violate FBI security requirements.

IF ISSUED A SECURITY BADGE

1. I will safeguard my access badge and display it only while in an FBI facility. I will not otherwise use my badge to indicate my relationship with the FBI.

2. I will immediately report to the FBI Security Programs Manager, Division Security Officer, or my FBI point of contact if my badge is lost, stolen, or misplaced.

3. I will not attempt entry with a badge that I know has been reported as being lost, stolen, misplaced or does not belong to me.

4. I will not give my badge to another person or allow another person to use my badge.

5. I will advise the FBI Security Programs Manager, Division Security Officer, or my FBI point of contact of the identity of any individual attempting to gain entry either illegally or by attempting to circumvent FBI security policies and procedures.

6. I acknowledge the Security badge to be FBI property and will ensure its return to FBI security when no longer needed.

7. I also understand the issuance of the Security badge does not entitle me to escort others within FBI space.

Date

Printed Signature

Written Signature

Address

Social Security Number

Company Name _

Witness: Position:

(Security Officer or other designated officials)

Date:

FD-979 (9-9-04) FBI File Number:

_____BB____________

Personnel Consent to Release Information To Whom It May Concern:

I hereby give consent to any authorized representative of the Federal Bureau of Investigation to obtain any information in your files pertaining to my academic, achievement, athletic, attendance, credit (including credit card and payment device numbers), disciplinary, employment, law enforcement (including, but not limited to, any record of charge, prosecution, or conviction for civil or criminal offenses), military, or professional license records (including any grievance records). I hereby direct each entity to which this form is presented to release such information upon request of the authorized recipient as described above, regardless of any other agreement or direction I may have made.

This consent is executed with full knowledge and understanding that the information is for the official use of the Federal Bureau of Investigation in connection with its determination of my suitability for employment and/or eligibility for new or continued access to classified information. Consent is granted for the Federal Bureau of Investigation to furnish such information as is described above to third parties in the course of fulfilling its official responsibilities.

Copies of this consent that show my signature are as valid as the original signed by me. This consent is valid until the termination of (i) my application for access to classified information or (ii) my affiliation with the Federal Bureau of Investigation, whichever is later.

Signature (sign in ink) Full Name (type or print clearly) Date Signed

Other Names Used Social Security Account No.

Signature of Parent or Guardian (if required) Place of Birth Date of Birth

Signature of Witness Name & Title of Witness

PRIVACY ACT STATEMENT

Authority: The collection of information requested by this form is authorized under Executive Order 10450, Security Requirements for Government Employees; Executive Order 12968, Access to Classified Information; and the Fair Credit Reporting Act, 15 U.S.C. §§1681 et seq. We are requesting your Social Security Account Number (SSAN) under Executive Order 9397, Numbering System for Federal Accounts Relating to Individual Persons. Providing requested information is voluntary; however, failure to furnish the requested information and consent will likely affect your eligibility for new or continued employment and/or access to classified information.

Principal Purpose: The information will be used principally to obtain such academic, achievement, athletic, attendance, credit, disciplinary, educational, employment, law enforcement, military, and professional license records as may be necessary to determine your suitability for employment and/or eligibility for new or continued access to classified information. Your SSAN identifies you throughout your affiliation with the U.S. Government and in most of the above-listed transactions. We will use your SSAN to accurately identify your records and to process investigations, inquiries, and/or determinations related to this consent.

Routine Uses: In addition to disclosures within the Department of Justice on a need-to-know basis, information reported on this form may be disclosed in accordance with all applicable routine uses as may be published at any time in the Federal Register, including all routine uses for the FBI Central Records System. These routine uses include the following disclosures: to potential sources in order to locate, seek, and obtain information or records pertaining to you; to any appropriate governmental authorities responsible for civil or criminal law enforcement, counterintelligence, or security matters to which the information may be relevant; to non-FBI employees performing Federal assignments; to courts or adjudicative bodies when the FBI considers it has an interest in the proceedings;

or as otherwise mandated by law, treaty, or Executive Order.

FBI/DOJ