Fillable Metropolitan Washington Airports Authority - Fingerprint Application Required

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Metropolitan Washington Airports Authority - Fingerprint Application Required

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Metropolitan Washington Airports Authority - Fingerprint Application Required by TSA Regulations
Fingerprint Collected by _________ (initials) at □ Ronald Reagan Washington National / □ Washington Dulles International
Rev. 05/20/2021
During the past 10 years before the date of this application have you been convicted or found not guilty by reason of insanity of any of
the following crimes? (Check “Yes” or “No” for each question)
1
Forgery of certificates, false markings, and other aircraft registration violations 49 USC 46306
□ Yes
□ No
2
Interference with air navigation 49 CFR 46308
□ Yes
□ No
3
Improper transportation of hazardous material 49 USC 46312
□ Yes
□ No
4
Aircraft piracy 49 USC 46502
□ Yes
□ No
5
Interference with flight crew member or flight attendant 49 USC 46504
□ Yes
□ No
6
Commission of certain crimes aboard aircraft 49 USC 46506
□ Yes
□ No
7
Carrying a weapon or explosive aboard aircraft 49 USC 46505
□ Yes
□ No
8
Conveying false information and threats 49 USC 46507
□ Yes
□ No
9
Aircraft piracy outside the special aircraft jurisdiction of the United States 49 USC 46502(b)
□ Yes
□ No
10
Lighting violations involving transporting controlled substance 49 USC 46315
□ Yes
□ No
11
Unlawful entry into an aircraft or airport area that serves air carriers or foreign air carriers contrary to
established security requirements 49 USC 46314
□ Yes
□ No
12
Destruction of an aircraft or aircraft facility 18 USC 32
□ Yes
□ No
13
Murder
□ Yes
□ No
14
Assault with intent to murder
□ Yes
□ No
15
Espionage
□ Yes
□ No
16
Sedition
□ Yes
□ No
17
Kidnapping or hostage taking
□ Yes
□ No
18
Treason
□ Yes
□ No
19
Rape or aggravated sexual abuse
□ Yes
□ No
20
Unlawful possession, use, sale, distribution, or manufacture of an explosive or weapon
□ Yes
□ No
21
Extortion
□ Yes
□ No
22
Armed or felony unarmed robbery
□ Yes
□ No
23
Distribution of, or intent to distribute, a controlled substance
□ Yes
□ No
24
Felony arson
□ Yes
□ No
25
A felony involving a threat
□ Yes
□ No
26
A felony involving willful destruction of property
□ Yes
□ No
27
A felony involving importation or manufacture of a controlled substance
□ Yes
□ No
28
A felony involving burglary
□ Yes
□ No
29
A felony involving theft
□ Yes
□ No
30
A felony involving dishonesty, fraud or misrepresentation
□ Yes
□ No
31
A felony involving possession, or distribution of stolen property
□ Yes
□ No
32
A felony involving aggravated assault
□ Yes
□ No
33
A felony involving bribery
□ Yes
□ No
34
A felony involving illegal possession of a controlled substance punishable by a maximum term of
imprisonment of more than one year
□ Yes
□ No
35.
Violence at international airport 18 USC 37
□ Yes
□ No
36.
Conspiracy or attempt to commit any of the aforementioned criminal acts
□ Yes
□ No
In accordance with federal regulations, I will inform the Metropolitan Washington Airports Authority – Pass & ID Office within 24
hours if I am convicted, or found not guilty by reason of insanity, of any of the crimes listed in #1 through #36 above while I am in
possession of an airport issued ID badge.
During the past 5 (five) years before the date of this application, have you had an airport issued ID badge □ Yes □ No
revoked for an airport security violation?
During the past 5 (five) years before the date of this application, have you been charged with a crime by the □ Yes □ No
Metropolitan Washington Airports Authority Police?
The information I have provided on this application is true, complete, and correct to the best of my knowledge and belief and is provided in
good faith. I understand that a knowing and willful false statement on this application can be punished by fine or imprisonment or both.
(See Section 1001 of Title 18 of the United States Code.)
Applicant’s Full Name (please print) _______________________________________________________________________
Applicant’s Signature ________________________________________________ Date Signed ____________
________
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Completed 21 July 2021

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