97
Page 49
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
(Provide explanation)
Provide document number
Other
U.S. Visa
U.S. Alien registration
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other
Quarterly
Employer name
I don't know
(Provide City
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
Complete the following if the relative listed is your
and is not a U.S. Citizen,
has a U.S. address and is not deceased.
18.4
18.5 Complete the following if the relative listed is your
and is not a U.S. Citizen,
has a foreign address and is not deceased.
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.
(Month/Year)
Present
Est.
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other
Quarterly
Employer name
I don't know
(Provide City
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.
(Month/Year)
Present
Est.
Entry #3
Entry #3
109
Page 50
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Enter your Social Security Number before going to the next page
Has this relative used any other names?
NO
YES
Not applicable
name, alias, or nickname).
City
State
Country
(Required)
Provide your relative's place of birth.
Middle name
Last name
Provide your relative's full name.
Suffix
First name
Suffix
Middle name
Last name
First name
If mother, provide your mother's maiden name.
Same as listed
18.1 Complete the following if the relative listed is your
Sister, Stepbrother, Stepsister, Half-brother, Half-sister.
I don't know
Middle name
First name
Last name
#1
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#2
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#3
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#4
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide relative type.
Country #1
Country #2
Provide your relative's country(ies) of citizenship.
Provide your relative's date of birth.
Est.
Date
(Month/Day/Year)
Section 18 - Relatives - (Continued)
Entry #4
Entry #4
56
Page 51
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
DS 1350
U.S. Passport
U.S. Naturalization certificate
U.S. Citizenship certificate
FS 240 or 545
None
Other
Provide document number.
(Provide explanation)
State
City
Street
Zip Code
(Provide explanation)
Provide your relative's current address. (
Provide City and Country if outside the United States; otherwise, provide City, State and Zip Code)
Provide your relative's APO/FPO address.
YES
NO
I don't know
Is your relative deceased?
YES
(If YES, proceed to 18.3)
NO
Zip Code
Does this relative have an APO/FPO address?
Address
APO or FPO
APO/FPO State Code
Street
City
State
Country
Zip Code
Complete the following if the relative listed is your
Sister, Stepbrother, Stepsister, Half-brother, Half-sister and is a U.S. Citizen, foreign born and is deceased.
OR
Complete the following if the relative listed is your
and is a U.S. Citizen,
foreign born and has a U.S. or APO/FPO address.
18.3
18.2 Complete the following if the relative listed is your
and is not deceased.
Entry #4
Entry #4
97
Page 52
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
(Provide explanation)
Provide document number
Other
U.S. Visa
U.S. Alien registration
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other
Quarterly
Employer name
I don't know
(Provide City
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
Complete the following if the relative listed is your
and is not a U.S. Citizen,
has a U.S. address and is not deceased.
18.4
18.5 Complete the following if the relative listed is your
and is not a U.S. Citizen,
has a foreign address and is not deceased.
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.
(Month/Year)
Present
Est.
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other
Quarterly
Employer name
I don't know
(Provide City
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.
(Month/Year)
Present
Est.
Entry #4
Entry #4
109
Page 53
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Enter your Social Security Number before going to the next page
Has this relative used any other names?
NO
YES
Not applicable
name, alias, or nickname).
City
State
Country
(Required)
Provide your relative's place of birth.
Middle name
Last name
Provide your relative's full name.
Suffix
First name
Suffix
Middle name
Last name
First name
If mother, provide your mother's maiden name.
Same as listed
18.1 Complete the following if the relative listed is your
Sister, Stepbrother, Stepsister, Half-brother, Half-sister.
I don't know
Middle name
First name
Last name
#1
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#2
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#3
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#4
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide relative type.
Country #1
Country #2
Provide your relative's country(ies) of citizenship.
Provide your relative's date of birth.
Est.
Date
(Month/Day/Year)
Section 18 - Relatives - (Continued)
Entry #5
Entry #5
56
Page 54
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
DS 1350
U.S. Passport
U.S. Naturalization certificate
U.S. Citizenship certificate
FS 240 or 545
None
Other
Provide document number.
(Provide explanation)
State
City
Street
Zip Code
(Provide explanation)
Provide your relative's current address. (
Provide City and Country if outside the United States; otherwise, provide City, State and Zip Code)
Provide your relative's APO/FPO address.
YES
NO
I don't know
Is your relative deceased?
YES
(If YES, proceed to 18.3)
NO
Zip Code
Does this relative have an APO/FPO address?
Address
APO or FPO
APO/FPO State Code
Street
City
State
Country
Zip Code
Complete the following if the relative listed is your
Sister, Stepbrother, Stepsister, Half-brother, Half-sister and is a U.S. Citizen, foreign born and is deceased.
OR
Complete the following if the relative listed is your
and is a U.S. Citizen,
foreign born and has a U.S. or APO/FPO address.
18.3
18.2 Complete the following if the relative listed is your
and is not deceased.
Entry #5
Entry #5
97
Page 55
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
(Provide explanation)
Provide document number
Other
U.S. Visa
U.S. Alien registration
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other
Quarterly
Employer name
I don't know
(Provide City
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
Complete the following if the relative listed is your
and is not a U.S. Citizen,
has a U.S. address and is not deceased.
18.4
18.5 Complete the following if the relative listed is your
and is not a U.S. Citizen,
has a foreign address and is not deceased.
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.
(Month/Year)
Present
Est.
Provide methods of contact (Check all that apply).
Telephone
Electronic (Such as e-mail, texting, chat rooms, etc)
In person
Written correspondence
Other
Provide approximate frequency of contact.
Monthly
Annually
Daily
Weekly
(Provide explanation)
Other
Quarterly
Employer name
I don't know
(Provide City
and Country if outside the United States; otherwise, provide City, State and Zip Code)
Street
City
State
Country
Zip Code
I don't know
(Provide explanation)
NO
YES
I don't know
service.
Provide approximate date of first contact.
(Month/Year)
Est.
Provide approximate date of last contact.
(Month/Year)
Present
Est.
Entry #5
Entry #5
109
Page 56
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Enter your Social Security Number before going to the next page
Has this relative used any other names?
NO
YES
Not applicable
name, alias, or nickname).
City
State
Country
(Required)
Provide your relative's place of birth.
Middle name
Last name
Provide your relative's full name.
Suffix
First name
Suffix
Middle name
Last name
First name
If mother, provide your mother's maiden name.
Same as listed
18.1 Complete the following if the relative listed is your
Sister, Stepbrother, Stepsister, Half-brother, Half-sister.
I don't know
Middle name
First name
Last name
#1
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#2
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#3
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Middle name
First name
Last name
#4
From
(Month/Year)
To
(Month/Year)
Suffix
Est.
Est.
Present
Maiden name?
YES
NO
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide the reason(s) why the name changed.
Provide relative type.
Country #1
Country #2
Provide your relative's country(ies) of citizenship.
Provide your relative's date of birth.
Est.
Date
(Month/Day/Year)
Section 18 - Relatives - (Continued)
Entry #6
Entry #6
56
Page 57
Form approved:
OMB No. 3206 0005
QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS
Standard Form 86
Revised December 2010
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736
Section 18 - Relatives - (Continued)
Enter your Social Security Number before going to the next page
DS 1350
U.S. Passport
U.S. Naturalization certificate
U.S. Citizenship certificate
FS 240 or 545
None
Other
Provide document number.
(Provide explanation)
State
City
Street
Zip Code
(Provide explanation)
Provide your relative's current address. (
Provide City and Country if outside the United States; otherwise, provide City, State and Zip Code)
Provide your relative's APO/FPO address.
YES
NO
I don't know
Is your relative deceased?
YES
(If YES, proceed to 18.3)
NO
Zip Code
Does this relative have an APO/FPO address?
Address
APO or FPO
APO/FPO State Code
Street
City
State
Country
Zip Code
Complete the following if the relative listed is your
Sister, Stepbrother, Stepsister, Half-brother, Half-sister and is a U.S. Citizen, foreign born and is deceased.
OR
Complete the following if the relative listed is your
and is a U.S. Citizen,
foreign born and has a U.S. or APO/FPO address.
18.3
18.2 Complete the following if the relative listed is your
and is not deceased.
Entry #6
Entry #6
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