FOR NLSC USE ONLY
OMB No. 0704-0449
NATIONAL LANGUAGE SERVICE CORPS (NLSC) APPLICATION
OMB approval expires
Nov 30, 2018
PLEASE RETURN YOUR COMPLETED FORM TO:
NATIONAL LANGUAGE SERVICE CORPS, P.O. BOX 12221, ARLINGTON, VA 22219-2221
The public reporting burden for this collection of information is estimated to average 18 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management
Division, 4800 Mark Center Drive, Alexandria, VA 22350-3100 (0704-0449). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any
penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 131, Office of the Secretary of Defense; DoD Directive 5124.02, Under Secretary of Defense for Personnel and Readiness (USD(P&R));
50 U.S.C. 1913, National Language Service Corps.
PRINCIPAL PURPOSE(S): To allow U.S. citizens with language skills to self-identify their skills for the purpose of temporary employment on an intermittent work
schedule or service opportunities in support of DoD or another department or agency of the United States. The information will be used to determine applicants' eligibility
for NLSC membership and to identify and contact NLSC members. Submitted forms are covered by Privacy Act System of Records Notice DHRA 07, National Language
Service Corps ( ).
ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended, the records or information therein
may be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows:
To another department or agency of the United States in need of temporary short-term foreign language services, where government employees are required or desired.
The DoD Blanket Routine Uses found at may apply to this collection.
DISCLOSURE: Voluntary; however, failure to provide information may result in non-enrollment in the NLSC and refusal to grant access to member areas of the NLSC
SECTION I - PERSONAL INFORMATION
b. LAST NAME
c. FIRST NAME
d. MIDDLE NAME
2.a. STREET ADDRESS
b. APARTMENT/SUITE NUMBER
e. ZIP CODE
3. TELEPHONE NUMBERS
4. E-MAIL ADDRESS
SECTION II - GENERAL INFORMATION
5. HOW DID YOU LEARN ABOUT THE NLSC?
(GREEN CARD HOLDER)
7. ARE YOU 18 YEARS OF AGE OR OLDER?
8. IF YOU ARE A MALE, U.S. CITIZEN AND AT LEAST 18 YEARS OLD, HAVE YOU REGISTERED WITH THE SELECTIVE
9. ARE YOU CURRENTLY OR HAVE YOU EVER BEEN A FEDERAL EMPLOYEE
Not a contractor)
10. HAVE YOU EVER BEEN A POLITICAL APPOINTEE IN ANY CAPACITY FOR THE U.S. GOVERNMENT?
11. HAVE YOU EVER SERVED IN THE ARMED FORCES?
12. IF YOU HAVE EVER HELD A SECURITY CLEARANCE, PLEASE ANSWER THE FOLLOWING:
(please specify )
13. ARE YOU WILLING TO TAKE A DRUG TEST?
14. ARE YOU WILLING TO UNDERGO A BACKGROUND CHECK
DD FORM 2932, JAN 2016
Page 1 of 5 Pages
PREVIOUS EDITION IS OBSOLETE.
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