Att 1B_V.7 OverseasVettingQuestionnaire.pdf

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OVERSEAS VETTING QUESTIONNAIRE

DS-7801 04.2024 v7.0 Page of

You must digitally sign before submitting Please make sure to sign upon completion. Be aware this willlock the form from further editing.

General Instructions All questions in this form must be answered completely and truthfully in order that the Government may make the determinations described below on a complete record. Penalties for inaccurate or false statements are discussed below. If you are a current Federal or contractor employee of the federal government: failure to answer any questions completely and truthfully could result in an adverse personnel action against you, including loss of employment.

Purpose of this Form This form will be used by the United States (U.S.) Government in conducting background investigations, reinvestigations, and continuous evaluations of persons for eligibility for logical access, physical access, credentialing, and fitness to perform work overseas for or on behalf of the U.S. Government as Locally Employed (LE) Staff (see 3 FAM 7121) and locally-hired third party contractors employed overseas at a U.S. Mission. For applicants, this form is to be used only after a conditional offer of employment has been made. This form is not to be used for National Security sensitive positions.

Providing this information is voluntary. If you do not provide each item of requested information, however, we will not be able to complete your investigation, which will adversely affect your ability to obtain or retain Federal or contract employment or logical or physical access. It is imperative that the information provided be true and accurate, to the best of your knowledge. Any information that you provide is evaluated on the basis of its currency, seriousness, relevance to the position and duties, and consistency with all other information about you. Withholding, misrepresenting, or falsifying information may affect your ability to obtain or retain Federal or contract employment. In addition, withholding, misrepresenting, or falsifying information may affect your eligibility for physical and logical access to federally controlled facilities or information systems. Withholding, misrepresenting, or falsifying information may also negatively affect your employment prospects and job status, and the potential consequences include, but are not limited to, removal, debarment from Federal service, or prosecution.

This form is a permanent document that may be used as the basis for future investigations, suitability or fitness for Federal employment, fitness for contract employment, or eligibility for physical and logical access to federally controlled facilities or information systems. Your responses to this form may be compared with your responses to previous questionnaires.

The investigation conducted on the basis of information provided on this form may be selected for studies and analyses in support of evaluating and improving the effectiveness and efficiency of the investigative and adjudicative methodologies. All study results released to the general public will delete personal identifiers such as name, social security number, and date and place of birth.

Authority to Request this Information Depending upon the purpose of your investigation, the U.S. Government is authorized to ask for this information under the Omnibus Diplomatic Security and Antiterrorism Act of 1986 and Executive Order 13467, as amended.

Your Social Security Number (SSN) is needed to identify records unique to you. Although disclosure of your SSN is not mandatory, failure to disclose your SSN may prevent or delay the processing of your background investigation. The authority for soliciting and verifying your SSN is Executive Order 9397, as amended.

any point during your investigation. The investigation may extend beyond the time covered by this form, when necessary to resolve issues. Your current employer may be contacted as part of the investigation, regardless of whether you have previously indicated in other applications or forms that you do not want your current employer contacted. If you have a security freeze on your consumer or credit report file, we may not be able to complete your investigation, which can adversely affect your ability to obtain or retain Federal or contract employment. To avoid such delays, you must request that the consumer reporting agencies lift the freeze in these instances.

In addition to the questions on this form, inquiry also is made about your adherence to security requirements, honesty and integrity, vulnerability to exploitation or coercion, falsification, misrepresentation, and any other behavior, activities, or associations that tend to demonstrate a person is not reliable, trustworthy, or loyal. Federal agency records checks may be conducted on your spouse, cohabitant(s), and immediate family members. After an eligibility determination has been completed, you also may be subject to continuous evaluation, which may include periodic reinvestigations, to determine whether retention in your position is clearly consistent with the interests of the Department of State.

Some investigations will include an interview with you as a routine part of the investigative process. The investigator may ask you to explain your answers to any question on this form. This provides you the opportunity to update, clarify, and explain information on your form more completely, which often assists in completing your investigation. It is imperative that the interview be conducted immediately after you are contacted. Postponements will delay the processing of your investigation, and declining to be interviewed may result in your investigation being delayed or canceled.

For the interview, you will be required to provide photo identification, such as a valid driver's license. You may be required to provide other documents to verify your identity, as instructed by your investigator.

These documents may include certification of any legal name change, Social Security card, passport, and/or your birth certificate. You may also be asked to provide documents regarding information that you provide on this form, or about other matters requiring specific attention. These matters include (a) alien registration or naturalization documents; (b) delinquent loans or taxes, bankruptcies, judgments, liens, or other financial obligations; (c) agreements involving child custody or support, alimony, or property settlements; (d) arrests, convictions, probation, and/or parole; or (e) other matters described in court records.

Your Personal Interview

1. Follow the instructions, provided to you by the office that gave you this form and any other clarifying instructions provided by that office to assist you with completion of this form. You must sign and date, in ink, the original and each copy you submit. You should retain a copy of the completed form for your records.

2. Type or legibly print your answers in ink. If the form is not legible, it will not be accepted. You may also be asked to submit your form using the approved electronic format.

3. All questions on this form must be answered. If no response is necessary or applicable, indicate this on the form with "N/A," unless otherwise noted.

4. Any changes that you make to this form, after you sign it, must be initialed and dated by you. Under extremely limited circumstances, agencies may modify your response(s) with your consent.

5. You must use the Location codes (abbreviations), immediately following the Privacy Act Routine Uses, when you fill out this form. Do not abbreviate the names of cities or foreign countries.

6. Place of birth requires Country entry, even if in the U.S.

Instructions for Completing this Form Background investigations for overseas positions are conducted to gather information to determine whether you are reliable, trustworthy, of good conduct and character, and loyal to the U.S. The information you provide in this form will be confirmed during your investigation. Be aware that the U.S. Government reserves the right to accomplish a final adjudication at The Investigative Process

7. For telephone numbers, ensure that the area code is included.

8. All dates provided in this form must be in Month/Day/Year or Month/Year format. Use numbers (01-12) to indicate months. For example, July 29, 1968, should be written as 07/29/1968. If you are unable to report the exact date, provide an estimated date which is the best of your ability to recall, and then enter "EST" in that field.

Final determination on your eligibility for position is the responsibility of the Federal agency that requested your investigation and the agency that conducted your investigation. You will be provided the opportunity to explain, refute, or clarify any information before a final decision is made, if an unfavorable decision is considered. The United States Government does not discriminate on the basis of race, color, religion, sex, national origin, disability, or sexual orientation when granting access to classified information.

Final Determination on Your Eligibility Penalties for Inaccurate or False Statements The U.S. Criminal Code (title 18, section 1001) provides that knowingly falsifying or concealing a material fact is a felony which may result in fines and/or up to five (5) years imprisonment. In addition, Federal agencies generally fire or disqualify individuals who have materially and deliberately falsified these forms, and this remains a part of the permanent record for future placements. Your prospects of placement are better if you answer all questions truthfully and completely. You will have adequate opportunity to explain any information you provide on this form and to make your comments part of the record.

The information you provide is for the purpose of investigating you for a position, and the information will be protected from unauthorized disclosure. The collection, maintenance, and disclosure of background investigative information are governed by the Privacy Act, where applicable. The agency that requested the investigation and the agency that conducted the investigation have published notices in the Federal Register describing the systems of records in which your records will be maintained. The information you provide on this form, and information collected during an investigation, may be disclosed without your consent by an agency maintaining the information in a system of records as permitted by the Privacy Act [5 U.S.C. 552a(b)], and by routine uses, a list of which are published by the agency in the Federal Register.

Disclosure Information 1.To the Department of Justice when: (a) the agency or any component thereof; or (b) any employee of the agency in his or her official capacity; or (c) any employee of the agency in his or her individual capacity where the Department of Justice has agreed to represent the employee; or (d) the United States Government, is a party to litigation or has interest in such litigation, and by careful review, the agency determines that the records are both relevant and necessary to the litigation and the use of such records by the Department of Justice is therefore deemed by the agency to be for a purpose that is compatible with the purpose for which the agency collected the records.

2.To a court or adjudicative body in a proceeding when: (a) the agency or any component thereof; or (b) any employee of the agency in his or her official capacity; or (c) any employee of the agency in his or her individual capacity where the Department of Justice has agreed to represent the employee; or (d) the United States Government is a party to litigation or has interest in such litigation, and by careful review, the agency determines that the records are both relevant and necessary to the litigation and the use of such records is therefore deemed by the agency to be for a purpose that is compatible with the purpose for which the agency collected the records.

Routine Uses 3.Except as noted in Sections 23 and 27, when a record on its face, or in conjunction with other records, indicates a violation or potential violation of law, whether civil, criminal, or regulatory in nature, and whether arising by general statute, particular program statute, regulation, rule, or order issued pursuant thereto, the relevant records may be disclosed to the appropriate Federal, foreign, State, local, tribal, or other public authority responsible for enforcing, investigating or prosecuting such violation or charged with enforcing or implementing the statute, rule, regulation, or order.

4.To any source or potential source from which information is requested in the course of an investigation concerning the hiring or retention of an employee or other personnel action, or the issuing or retention of a security clearance, contract, grant, license, or other benefit, to the extent necessary to identify the individual, inform the source of the nature and purpose of the investigation, and to identify the type of information requested.

5.To a Federal, State, local, foreign, tribal, or other public authority the fact that this system of records contains information relevant to the retention of an employee, or the retention of a security clearance, contract, license, grant, or other benefit. The other agency or licensing organization may then make a request supported by written consent of the individual for the entire record if it so chooses. No disclosure will be made unless the information has been determined to be sufficiently reliable to support a referral to another office within the agency or to another Federal agency for criminal, civil, administrative, personnel, or regulatory action.

6.To contractors, grantees, experts, consultants, or volunteers when necessary to perform a function or service related to this record for which they have been engaged. Such recipients shall be required to comply with the Privacy Act of 1974, as amended.

7.To the news media or the general public, factual information the disclosure of which would be in the public interest and which would not constitute an unwarranted invasion of personal privacy.

8.To a Federal, State, or local agency, or other appropriate entities or individuals, or through established liaison channels to selected foreign governments, in order to enable an intelligence agency to carry out its responsibilities under the National Security Act of 1947 as amended, the CIA Act of 1949 as amended, Executive Order 12333 or any successor order, applicable national security directives, or classified implementing procedures approved by the Attorney General and promulgated pursuant to such statutes, orders or directives.

9.To a Member of Congress or to a Congressional staff member in response to an inquiry of the Congressional office made at the written request of the constituent about whom the record is maintained.

10.To the National Archives and Records Administration for records management inspections conducted in accordance with 44 U.S.C. 2904 and 2906.

11.To the Office of Management and Budget when necessary to the review of private relief legislation.

This privacy act statement is located on the back of the FD-258 fingerprint card.

Authority: The FBI’s acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub. L. 92-544, Presidential Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application.

Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI’s Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI.

Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI’s Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, and other suitability determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety.

INFORMATION PROVIDED BY THE FEDERAL BUREAU OF INVESTIGATION

Privacy Act Statement As an applicant who is the subject of a national fingerprint-based criminal history record check for a noncriminal justice purpose (such as an application for employment or a license, an immigration or naturalization matter, security clearance, or adoption), you have certain rights which are discussed below. All notices must be provided to you in writing1. These obligations are pursuant to the Privacy Act of 1974, Title 5, United States Code (U.S.C.) Section 552a, and Title 28 Code of Federal Regulations (CFR), 50.12, among other authorities.

* You must be provided an adequate written FBI Privacy Act Statement (dated 2013 or later) when you submit your fingerprints and associated personal information. This Privacy Act Statement must explain the authority for collecting your fingerprints and associated information and whether your fingerprints and associated information will be searched, shared, or retained.2

* You must be advised in writing of the procedures for obtaining a change, correction, or update of your FBI criminal history record as set forth at 28 CFR 16.34.

* You must be provided the opportunity to complete or challenge the accuracy of the information in your FBI criminal history record (if you have such a record).

* If you have a criminal history record, you should be afforded a reasonable amount of time to correct or complete the record (or decline to do so) before the officials deny you the employment, license, or other benefit based on information in the FBI criminal history record.

* If agency policy permits, the officials may provide you with a copy of your FBI criminal history record for review and possible challenge. If agency policy does not permit it to provide you a copy of the record, you may obtain a copy of the record by submitting fingerprints and a fee to the FBI. Information regarding this process may be obtained at https://www.fbi.gov/services/cjis/identity-history-summary-checks and https://www.edo.cjis.gov.

* If you decide to challenge the accuracy or completeness of your FBI criminal history record, you should send your challenge to the agency that contributed the questioned information to the FBI. Alternatively, you may send your challenge directly to the FBI by submitting a request via https://www.edo.cjis.gov. The FBI will then forward your challenge to the agency that contributed the questioned information and request the agency to verify or correct the challenged entry. Upon receipt of an official communication from that agency, the FBI will make any necessary changes/corrections to your record in accordance with the information supplied by that agency. (See 28 CFR 16.30 through 16.34.)

* You have the right to expect that officials receiving the results of the criminal history record check will use it only for authorized purposes and will not retain or disseminate it in violation of federal statute, regulation or executive order, or rule, procedure or standard established by the National Crime Prevention and Privacy Compact Council.3

1 Written notification includes electronic notification, but excludes oral notification 2 https://www.fbi.gov/services/cjis/compact-council/privacy-act-statement 3 See 5 U.S.C. 552A(B); 28 U.S.C. 534(B); 34 U.S.C. 40316 (formerly cited as 42 U.S.C. 14616), Article IV(c); 28 CFR 20.21(c), 20.33(d) and 906.2(d).

Noncriminal Justice Applicant’s Privacy Rights PERSONS COMPLETING THIS FORM SHOULD BEGIN AFTER CAREFULLY READING THE PRECEDING INSTRUCTIONS.

I have read the instructions and I understand that if I withhold, misrepresent, or falsify information on this form, I am subject to the penalties for inaccurate or false statement (per U.S. Criminal Code, Title 18, section 1001), or removal and debarment from Federal or contract employment.

SECTION 1 – Personal Information Date of Birth Sex Place of Birth if born in the US, enter the state postal abbreviation (such as CA, NY) in the state field Have you ever used another birth date in legal documentation?

1A - Former Names/Aliases Have you been known by any other names?

Complete the following if you have responded 'Yes' to having used other names:Enter your Surname, Given Name, and Middle Name in the spaces provided. If you only have initials in your name, provide them under the "Surname" and indicate "(Initials only)". When entering a date (MM/DD/YYYY) provide the exact date if known or if your do not recall the exact date enter your best estimate of what you believe the exact date to be and mark the "Est" box next to that entry. You must provide the reason you changed your name.

1A.1 - Alias Information (Click the button to add or remove alias fields) Dates name used (MM/DD/YYYY) Provide the reason for the name change.

1B - Citizenship & Identification 1B.1 - Citizenship (Click to the right to add/remove countries of citizenship) Provide the name of the country and the period of time you held citizenship with this country (if multiple proofs of citizenship are being entered for the SAME COUNTRY: click '+', enter the same country and time period, and add the additional ID information) Proof of Citizenship The name the citizenship was issued under 1B.2 - Forms of Identification (Provide as many as possible by clicking '+' to the right) 1B.3 - Permanent Resident Card Have you ever been issued a Permanent Resident Card (Alien Registration Number or USCIS Number) by the US Government?

Provide US Permanent Resident Card information (Click to the right to add/remove ID Information) 1B.4 - Social Security Number Have you ever been issued a Social Security Number by the US Government?

Provide US Social Security Number Information (Click to the right to add/remove social security card information) 1C - Physical Description Hair Eye Height (meters or feet/inches) Weight (kilograms or pounds) Describe any unique features or identifying marks on your body. (Example: I have star shaped scars on my left shoulder and chin.)

1D - Contact & Social Media 1D.1 - Contact Information Please provide your current contact information 1D.2 - Social Media Membership Provide all social media that you currently use. Select 'Other' if one you use isn't listed in the drop-down and write it the social media name.

SECTION 2 – Residency History List the places where you have lived beginning with your current residence and working back seven years. Residences for the entire period must be accounted for without breaks. Indicate the actual physical location of your residence, not a Post Office box or a permanent residence where you were not physically located. If you split your time between one or more residences during a time period, you must list all residences. Do not list residence before your 18th birthday unless you are doing this to provide a minimum of two years residence history.

You are not required to list temporary locations of less than 90 days that did not serve as your permanent or mailing address.

For your current address provide a person who knows you at that address, and who preferably still lives in that area. Do not list people who knew you well for residences completely outside this period, and do not list your spouse, cohabitant or other relatives.

Have you lived in the United States for more than six (6) months continuously during the past seven (7) years?

2A - Current Residence Provide the dates in which you lived in this residence. If you do not recall the exact date enter your best estimate and mark the "Est" box Residency Status:

2A.1 - Landlord's Contact Information 2A.2 - Neighbor's Contact Information 2B - Prior Residences 2B.1 - Residence Information Provide the dates in which you lived in this residence. If you do not recall the exact date enter your best estimate and mark the "Est" box Residency Status:

2B.2 - Neighbor's Contact Information SECTION 3 - Education History Have you attended an educational institution in the last seven years?

3A - Recent Schooling (Click to the right to add/remove schools) Did you attend an educational institution more than seven years ago?

3B - Previous Schooling (Click to the right to add/remove schools) SECTION 4 - Employment History If you have never held a job/work position before, proceed immediately to the next section. If this is not the case please list all of your employment activities, including unemployment and self-employment, beginning with the present and working back seven years. The entire period must be accounted for without breaks. If the employment activity was military duty, list separate employment activity periods to show each change of military duty station. Provide separate entries for employment activities with the same employer but having different physical addresses. Do not list employment before your 18th birthday unless to provide a minimum of 2 years employment history.

4A - Employment (All employment in the last 7 years) Select the type of employment (employed, unemployed, military) and enter the time period related to it (If you do not recall the exact date enter your best estimate and mark the "Est" box). You must account for the last 7 years with no interruptions Provide the organization's address and a supervisor's contact information (if unemployed, provide contact info for someone who can verify).

4B - Additional Employment Information Have you served in the US Military Service more than 7 years ago?

4B.1 - Military Service Description If you have no military discharge date, leave the field blank Military Duty Assignments Provide the time frame you were assigned to this unit/organization. (If you don't recall an exact date enter your best estimate and mark the "Est" box) Have you worked for a government (excluding the US) organization/military more than seven (7) years ago?

4B.2 - General Foreign Service Description If you have no military discharge date, leave the field blank Foreign Government Information Provide the time frame you were assigned to this unit/organization. (If you don't recall an exact date enter your best estimate and mark the "Est" box) SECTION 5 - Social References Provide contact information for three (3) persons who are not family relations and are not listed in other sections of this form 5A - Social Reference 1 (Provide contact information for a person who knew you during the past seven (7) years.)

How long have you known this person?

5B - Social Reference 2 (Provide contact information for a person who knew you during the past seven (7) years.)

How long have you known this person?

5C - Social Reference 3 (Provide contact information for a person who knew you during the past seven (7) years.)

How long have you known this person?

Section 6 - Marital Status/Domestic Union Status/Domestic Partnership Status Provide your current status (check all that apply) 6A - Current Partners/Spouses Start of relationship Relationship type Citizenship (Click to the right to add/remove countries of citizenship) Place of Birth if born in the US, enter the state postal abbreviation (such as CA, NY) in the state field Provide your Spouse/Domestic Partner's address if different than yours.

6B - Former Partners/Spouses How long did this relationship last?

Relationship Type Citizenship (Click to the right to add/remove countries of citizenship) Place of Birth if born in the US, enter the state postal abbreviation (such as CA, NY) in the state field Provide your Former Spouse/Domestic Partner's address if different than yours.

SECTION 7 – Relationships 7A - Parents 7A.1 - Parent (Click to the right to add/remove parents) Relationship to you Citizenship (Click to the right to add/remove countries of citizenship) Provide contact information Provide a current address if different from your own 7B - Siblings 7B.1 - Sibling (Click to the right to add/remove sibling) Relationship to you Citizenship (Click to the right to add/remove countries of citizenship) Provide contact information Provide a current address if different from your own 7C - Children 7C.1 - Child (Click to the right to add/remove children Relationship to you Citizenship (Click to the right to add/remove countries of citizenship) Provide contact information Provide a current address if different from your own SECTION 8 - Foreign Travel Have you traveled outside the country in the past seven (7) years?

Provide the following details and click "+" to record more travel (If you don't recall the exact date enter your best estimate and mark the "Est" box) Foreign Trip Details SECTION 9 - Prior Investigations Has the United States Government (or any foreign government) EVER investigated you?

Did the investigation result in your clearance being denied/revoked?

SECTION 10 - General Questions 10A - Financial 10A.1 - Have you experienced difficulty paying your bills during the past seven (7) years?

10A.2 - Has the financial difficulty mentioned in the previous question been resolved?

10A.3 - Have you formally declared bankruptcy (an inability to pay your debts) during the past seven (7) years?

10A.4 - Have you, your spouse, cohabitant, or dependent children EVER had financial interests (such as stocks, property, investments, bank accounts, ownership of corporate entities, corporate interests or businesses) in a country other than that of your citizenship?

10B - Legal 10B.1 - In the past (7) years, have you been issued a summons, citation, or ticket to appear in court in a criminal proceeding against you?

10B.2 - In the past (7) years, have you been charged, convicted, or sentenced with a crime in any court?

10B.3 - In the past (7) years, have you been a party to any public record civil court action not listed elsewhere on this form?

10B.4 - Have you been debarred from government employment?

10B.5 - Have you been arrested, detained, or questioned by police in the past seven (7) years?

10B.6 - Have you illegally or without proper authorization accessed or attempted to access any information technology system?

10B.7 - Have you ever used any drugs or controlled substances? (Use of a drug or controlled substance includes injecting,snorting, inhaling, swallowing, experimenting with or otherwise consuming any drug or controlled substance) 10B.8 - Have you ever used any drugs or controlled substances without a doctor's prescription?

10B.9 - Have you ever been involved in trafficking substances such as weapons, persons, drugs, controlled substances, etc.?

10C - Associations & Conduct 10C.1 - Do you, your associates, or family have connections to any persons, groups, governments, or countries that create a conflict of interest?

10C.2 - Have you been involved in any act of sabotage, espionage, treason, terrorism or other acts to overthrow a government?

10C.3 - Have you associated or sympathized with persons involved in sabotage, espionage, treason, terrorism or similar acts?

10C.4 - Have you engaged in conduct which may make you vulnerable to coercion, exploitation, or blackmail?

10C.5 - Have you concealed information which may make you vulnerable to coercion, exploitation, or blackmail?

10D - Additional Disclosures SECTION 11 - Certification My statements on this form, and on any attachments to it, are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I have carefully read the foregoing instructions, routine uses, and statements pertaining to the Privacy Act. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (18 U.S.C. 1001). I understand that intentionally withholding, misrepresenting, or falsifying information may have a negative effect on my security certification, physical access, OSHP certification, employment prospects, or job status, up to and including denial or revocation of my security certification, physical access, or OSHP certification or my removal from Federal service.

SECTION 12 - Completion Assistance Was a translator or aid used to complete this form?

Translator Information 6.1.0.20150517.1.919161.918415

AUTHORIZATION FOR RELEASE OF INFORMATION

Please carefully read this authorization to release information about you. If you agree to the terms of this authorization, sign and date this form below.

I Authorize any investigator, special agent, or other duly accredited representative of the United States Department of State (State) or other authorized Federal agency conducting my background investigation, reinvestigation, or ongoing evaluation of my eligibility for a security certification, physical access, or an Overseas Seasonal Hire Program (OSHP) certification to obtain any information relating to my activities, conduct, and character. This information may include, but is not limited to, current and historic academic, residential, achievement, performance, attendance, disciplinary, employment, criminal, financial and credit information, and publicly available social media information.

I Understand that, for these purposes, publicly available social media information includes any electronic social media information that has been published or broadcast for public consumption, is available on request to the public, is accessible online to the public, is available to the public by subscription or purchase, or is otherwise lawfully accessible to the public. I further understand that this authorization does not require me to provide passwords; log into a private account; or take any action that would disclose non-publicly available social media information.

I Authorize any investigator, special agent, or other duly accredited representative of State, the Federal Bureau of Investigation, the Department of Defense, the Department of Homeland Security, the Office of the Director or National Intelligence, the Office of Personnel Management, and any other authorized Federal agency, to request criminal record information about me from criminal justice agencies for the purpose of determining my eligibility for a security certification consistent with 5 U.S.C. 9101 and Executive Order 13467, June 30, 2008, as amended. I understand that I may request a copy of such records as may be available to me under the law.

I Authorize custodians of records and other sources of information pertaining to me to release such information upon request of the investigator, special agent, or other duly accredited representative of State or any Federal agency authorized above regardless of any previous agreement to the contrary.

I Understand that the information released by records custodians and sources of information is for official use by State only for the purposes provided in this Overseas Vetting Questionnaire, and that it may be disclosed only as authorized by law.

I Authorize the information to be used to conduct officially sanctioned and approved personnel security-related studies and analyses, which will be maintained in accordance with the Privacy Act, where applicable.

Photocopies of this authorization with my signature are valid. This authorization shall remain in effect so long as I am applying for or retain a security certification, physical access, or OSHP certification.