Cbp Form 3078 - Application For Identification Card - Department Of Homeland Security Page 2

Download a blank fillable Cbp Form 3078 - Application For Identification Card - Department Of Homeland Security in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Cbp Form 3078 - Application For Identification Card - Department Of Homeland Security with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

30. PREVIOUS EMPLOYMENT -- LIST IN CHRONOLOGICAL ORDER, GIVING EARLIEST EMPLOYMENT FIRST (Last 10 Years)

DATES

EMPLOYER NAME AND ADDRESS

OCCUPATION

From

31. HAVE YOU EVER BEEN CONVICTED OF ANY CRIME OR OFFENSE (Other than traffic violations, you

YES (If YES, explain

may exclude any items which occurred before your 16th birthday) IN THIS COUNTRY OR ELSEWHERE?

in Item 32.)

32. EXPLANATION OF ALL CONVICTIONS (Federal, State, Military, or Foreign)

Final Disposition

Date

Place

Charge

Court

33. DO YOU NOW USE OR HAVE YOU EVER USED NARCOTIC DRUGS?

YES (If YES, explain

34. ATTACH PHOTOGRAPH HERE

below.)

I certify that all of the statements made in this Application are

SIGNATURE (Sign in ink)

DATE

35.

true, complete, and correct to the best of my knowledge and

CERTIFICATION

belief, and are made in good faith.

Paperwork Reduction Act Notice: The Paperwork Reduction Act says we must tell you why we are collecting this information, how we will use it, and whether

you have to give it to us. We ask for this information to carry out U.S. Customs and Border Protection laws of the United States. This form is used by

licensed cartmen or lightermen or their employees as an application to apply for a CBP identification card and is required to obtain or retain a benefit. The

estimated average burden associated with this collection of information is 17 minutes per respondent or recordkeeper depending on individual circumstances.

The valid OMB Control Number for this Information Collection is 1651-0008.

Pursuant to the requirements of Public law 93-579 (Privacy Act of 1974), notice is hereby given that the authority to collect information on CBP Form 3078 is

5 U.S.C. 301, Reorganization Plan No. 1 of 1950; 19 U.S.C. 1551, 1565, 1624, 1641; 19 CFR 112.42. The principal purpose for collecting the information is

to enable CBP to conduct a background investigation and thereby determine whether the applicant meets the criteria required for the issuance of an

identification card. The information collected and contained in the applicant's file may be provided to those employees of CBP who have a need for the

records in the performance of their duties. The information may also be used, when deemed appropriate, in a proceeding to revoke or suspend the

identification card. Disclosure of all information requested on CBP Form 3078 is voluntary; however, failure to disclose some or all of this information may

result in CBP's inability to conduct the required background investigation.

CBP Form 3078 (04/08)