6-86c Questionnaire Form.pdf

This document is a Background Investigation form from the Oklahoma City Area Indian Health Service. The form requires an individual to provide comprehensive personal information, including a detailed residence history for the past five years. It includes a checklist of states where the applicant has lived or worked, with options for 44 different states, and space to document other names used, physical addresses, and residency details from the current time and previous years. The form is designed to collect thorough background information for what appears to be a screening or employment process, with sections for full name, email address, residence history, and state residency verification.