Dd Form 2981 - Defense Technical Information Center Page 3
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3INSTRUCTIONS FOR COMPLETING DD FORM 2981
This Department of Defense Form is to be completed by prospective employees and/or volunteers upon application for any position
within a Department of Defense Child or Youth Program. The form will be utilized for initial and annual certification that said employee/
volunteer has not been arrested, charged, or convicted by Federal, State, or other Law enforcement authorities for any violation of any
Federal law, Military law, State law, County or Municipal law, Regulation or Ordinance, nor have they been arrested, charged or held by
Federal, State or Other Law Enforcement Authorities for any crime or offense involving any of the following: Crime involving a child, sex
crime, drug or alcohol offense, domestic violence, violent crime/assaultive behavior, or other.
Completion of this form is voluntary; however, failure to furnish all requested information may result in an unfavorable adjudication
decision and may affect suitability of working with or around children.
1.
Provide your last, first and middle name. Do not use initials or abridgements.
2.
Provide any other names used to include maiden name.
3.
Provide your place of birth to include city, state and country.
4.
Provide your date of birth in mm/dd/yyyy format.
5.
Provide gender.
6.
Provide the installation or DoD CY program where you seek employment or to volunteer.
7.
Provide the date of hire. This is to be completed by CDP staff only.
8. a. Place an X in the appropriate box if you have or have not been arrested, charged, or convicted by Federal, State, or other Law
enforcement authorities for any violation of any Federal law, Military law, State law, County or Municipal law, Regulation or
Ordinance? (Do not include anything that happened before your 16th birthday. Leave out traffic fines of less than $300.)
8. b. Place an X in the appropriate box if you have been arrested, charged or held by Federal, State or Other Law Enforcement
Authorities for any crime or offense involving any of the following: Mark Yes or No for each category. Failure to provide information
may result in an unfavorable adjudication decision. All other charges must be included in the space provided below, even if they
were dismissed. If you answered “Yes,” explain your answer in the space provided below.
8. b. 1-6 Provide all specifics to any arrests, charges, or convictions in the provided space. If additional space is needed, use block 10.
9.
On an annual basis, place an X in the appropriate box indicating if you have or have not been arrested, charged or held by law
enforcement in regard to anything mentioned in block 8 above.
DD FORM 2981 INSTRUCTIONS, MAY 2014
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