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SUBMITTING CANDIDATES
FOR ACCESS TO
FBI FACILITIES
2018
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)
Attachment 24 15F06719R000004 0007 RMACC
1
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
Attachment 24 15F06719R000004 0007 RMACC
2
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
Attachment 24 15F06719R000004 0007 RMACC
3
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. *
•
Attachment 24 15F06719R000004 0007 RMACC
4
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
Attachment 24 15F06719R000004 0007 RMACC
5
FD-316 DOCUMENT REQUIREMENTS
Attachment 24 15F06719R000004 0007 RMACC
6
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
Attachment 24 15F06719R000004 0007 RMACC
7
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
Attachment 24 15F06719R000004 0007 RMACC
8
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.
Attachment 24 15F06719R000004 0007 RMACC
9
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
Attachment 24 15F06719R000004 0007 RMACC
13
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.
Attachment 24 15F06719R000004 0007 RMACC
14
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.
Attachment 24 15F06719R000004 0007 RMACC
15
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
Attachment 24 15F06719R000004 0007 RMACC
16
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
Attachment 24 15F06719R000004 0007 RMACC
Limited Background Investigation
Packet
(LBI)
Federal Bureau of Investigation
2017-2018
Attachment 24 15F06719R000004 0007 RMACC
Attachment 24 15F06719R000004 0007 RMACC
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Attachment 24 15F06719R000004 0007 RMACC
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)
Attachment 24 15F06719R000004 0007 RMACC
Finance and Facilities Division
■
■
Construction/Servicing
As needed
X
X
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 APPLICABLE
- -
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.
Attachment 24 15F06719R000004 0007 RMACC
FD-857a (9-9-2016)
S
ENSITIVE 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.
Attachment 24 15F06719R000004 0007 RMACC
7
.
U
nless and until I am released in writing by an authorized representative of the FBI, I understand that a
ll
c
onditions 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. E
ach provision of this Agreement is severable. If a court should find any provision of this Agreement t
o
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.
1
0.
I
have read this Agreement carefully and my questions, if any, have been answered.
S
ignature ________________________________________________________ Date __________________
Organization (if contractor, provide name and address):
The briefing and execution of this Agreement was witnessed by __________________________________________
(Type or Print Name)
S
ignature ________________________________________________________ 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.
S
ignature ______________________________________________________ Date __________________
Name of Witness (Type or Print) __________________________________________________________
Signature of Witness _____________________________________________ Date __________________
Attachment 24 15F06719R000004 0007 RMACC
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
Attachment 24 15F06719R000004 0007 RMACC
____________________________________________________________________________________
_____________________________________________
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: ________________________
Attachment 24 15F06719R000004 0007 RMACC
FD-835a (1-25-02)
F
OREIGN 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.
Attachment 24 15F06719R000004 0007 RMACC
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:
Attachment 24 15F06719R000004 0007 RMACC
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
Attachment 24 15F06719R000004 0007 RMACC
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Form 2018: Attachment 24 15F06719R000004 0007 RMACC (City of Oakland)

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Completed 2 July 2021

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