Security Clearance Application
Personal Information
First Name
Last Name
Date of Birth
Social Security Number
Current Address
Phone Number
Email Address
Employment Information
Current Employer
Position/Title
Length of Employment
Requested Clearance Level
Confidential
Secret
Top Secret
Background
U.S. Citizenship Status
Have you previously held a security clearance?
Yes
No
Criminal History (if any)
Foreign Contacts/Associations
References
Reference 1 (Name, Relationship, Contact)
Reference 2 (Name, Relationship, Contact)
Reference 3 (Name, Relationship, Contact)
Additional Information
Comments or Additional Information