Cap Form 83 - Civil Air Patrol Counterdrug Application Page 2
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2CIVIL AIR PATROL COUNTERDRUG MISSION NONDISCLOSURE AGREEMENT
By signing this form I realize that due to my current affiliation with the Drug Enforcement Administration (DEA), Bureau of
Immigration and Customs Enforcement (BICE), and the U.S. Forest Service (USFS), I hereby declare that I intend to be
governed by and will comply with the following provisions:
(1) I understand that unauthorized disclosure of information I may acquire as a Civil Air Patrol counterdrug (CD) mission
crew member could place human life in jeopardy, or result in the denial of "due process" to a person or persons who are
targets of investigations, or prevent the above listed agencies from effectively discharging their responsibilities.
(2) I agree that I will never divulge, publish, or reveal either by word or conduct or by any other means disclose to any
unauthorized recipient, any information acquired as part of the performance of my duties as a CD crew member or CD mission
coordinator where any such divulgence, publication, revelation or disclosure would be contrary to law, regulation or public policy.
(3) I understand unauthorized disclosure could be a violation of Federal law and subject to prosecution as a criminal
offense. I accept the above provisions as conditions for my participation in the CAP CD mission. I agree to comply with
these provisions both during my tenure in the CAP CD mission and following termination of such tenure.
(4) I authorize Law Enforcement Agencies to conduct background checks during the screening process.
CIVIL AIR PATROL COUNTERDRUG MISSION STATEMENT OF UNDERSTANDING
Pursuant to the Agreement among the Civil Air Patrol, Drug Enforcement Administration, Bureau of Immigration and
Customs Enforcement, U.S. Forest Service and the Air Force, I may be asked to assist the Bureau of Immigration and
Customs Enforcement, Drug Enforcement Administration, or U.S. Forest Service by providing and operating CAP aircraft
for law enforcement officers who will conduct reconnaissance to detect illegal activity. I understand the dangers that may
result from these patrol flights, which might put me in close proximity to armed drug traffickers. However, I agree I will
neither possess nor use any weapons while on a counterdrug (CD) mission, nor will I physically participate in arrest or
detention procedures or search and seizure of evidence. I further understand that due to the sensitive nature of this
mission, a security screening of participating CAP member is required, and I further understand
1.
that this form will be submitted to the Drug Enforcement Administration (DEA) and the Bureau of Immigration and
Customs Enforcement (BICE) as part of their mandatory screening process;
2.
that successful screening by these agencies is required before I will be permitted to perform certain volunteer service
for these and other federal agencies;
3.
that false statements to federal agencies is a criminal offense under Title 18, United States Code, Section 1001;
4.
that furnishing the required information is voluntary, but failure to accurately provide complete information may result in
denial of clearance and/or termination of Civil Air Patrol membership; and
5.
rejection by either DEA or BICE, for any reason, may result in resubmission of my fingerprints to the FBI for
membership screening in accordance with CAPR 39-2.
6.
that I authorize submission of this form to DEA and BICE.
APPLICANT SIGNATURE
Date
(PLEASE SIGN WITH INK) (ORIGINAL SIGNATURE REQUIRED)
WING CDO OR
REGION CDD
Date
(PLEASE SIGN WITH INK) (ORIGINAL SIGNATURE REQUIRED)
CAP WG/CC OR
CAP REGION CC OR
Date
(PLEASE SIGN WITH INK) (ORIGINAL SIGNATURE REQUIRED)
(PLEASE PRINT WING/CC, REGION/CC NAME)
DEA CERTIFICATION
Date
BICE CERTIFICATION
Date
CAP FORM 83, FEB 04
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