Standart Form 85 - Questionnaire For Non-Sensitive Positions Page 3
Download a blank fillable Standart Form 85 - Questionnaire For Non-Sensitive Positions 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 Standart Form 85 - Questionnaire For Non-Sensitive Positions 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.
ADVERTISEMENT
1
2
3
4
5
6
7
8Standard Form 85 (EG)
Form approved:
Revised September 1995
OMB No. 3206-0005
QUESTIONNAIRE FOR
U.S. Office of Personnel Management
NSN 7540-00-634-4035
NON-SENSITIVE POSITIONS
5 CFR Parts 731 and 736
85-111
Codes
Case Number
OPM
USE
ONLY
Agency Use Only (Complete items A through K using instructions provided by USOPM)
Month
Day
Year
A
Type of
B
Extra
C
Nature of
D
Date of
Investigation
Coverage
Action Code
Action
E
Geographic
F
Position
G
H
Location
Title
SON
SOI
I
OPAC-ALC
J
Accounting Data and/or
Number
Agency Case Number
Requesting Name and Title
Signature
Telephone Number
Date
K
Official
(
)
Persons completing this form should begin with the questions below.
1
2
FULL
If you have only initials in your name, use them and state (IO).
- If you are a "Jr.," "Sr.," "II," etc., enter this in the
DATE OF
NAME
If you have no middle name, enter "NMN".
box after your middle name.
BIRTH
Last Name
First Name
Middle Name
Jr., II, etc.
Month
Day
Year
3
4
PLACE OF BIRTH - Use the two letter code for the State.
SOCIAL SECURITY
Country (if not in the United States)
City
County
State
OTHER NAMES USED
5
Give other names you used and the period of time you used them (for example: your maiden name, name(s) by a former marriage, former name(s), alias(es), or
nickname(s)) . If the other name is your maiden name, put "nee" in front of it.
Name
Month/Year
Month/Year
Name
Month/Year
Month/Year
#1
#3
To
To
Name
Month/Year
Month/Year
Name
Month/Year
Month/Year
#2
#4
To
To
6
SEX (Mark one box)
Female
Male
Your Mother’s Maiden Name
7
b
CITIZENSHIP
I am a U.S. citizen or national by birth in the U.S. or U.S. territory/possession. (Answer
items b and d)
a
Mark the box at the right that
I am a U.S. citizen, but I was NOT born in the U.S. (Answer items b , c and d)
reflects your current citizenship
status, and follow its instructions.
I am not a U.S. citizen. (Answer items b and e)
c
UNITED STATES CITIZENSHIP
If you are a U.S. citizen, but were not born in the U.S., provide information about one or more of the following proofs of your citizenship.
Naturalization Certificate (Where were you naturalized?)
Court
City
State
Certificate Number
Month/Day/Year Issued
Citizenship Certificate (Where was the certificate issued?)
City
State
Certificate Number
Month/Day/Year Issued
State Department Form 240 - Report of Birth Abroad of a Citizen of the United States
Give the date the form was
Month/Day/Year
Explanation
prepared and give an explanation
if needed
U.S. Passport
Passport Number
Month/Day/Year Issued
This may be either a current or previous U.S. Passport.
Country
d
DUAL CITIZENSHIP
If you are (or were) a dual citizen of the United States and
another country, provide the name of that country in the space to
the right.
e
ALIEN If you are an alien, provide the following information:
City
State
Date You Entered U.S.
Alien Registration Number
Country(ies) of Citizenship
Place You
Month
Day
Year
Entered the
United States:
Exception to SF85, SF85P, SF85P-S, SF86, and SF86A approved by GSA September, 1995.
Page 1
Designed using Perform Pro, WHS/DIOR, Sep 95
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal