AEA Form 604-1B: Security Questionnaire for a Simple Security Check

Under 1.1 Personal data, Name: your last name.

Add to your previous names additions such as "née/né", "former married name" etc. (e.g., "former married name Maier").

First name(s) (underline name by which you are called): use the spelling contained in your birth certificate (do not use any abbreviated spelling).

Place of birth: use the spelling contained in your birth certificate. If the name of the town has changed meanwhile (e. g., due to territorial re-organisation), indicate the new name of the town with the postal code in brackets; this does not apply if your place of birth is outside the Federal Republic of Germany.

Nationality (including dual nationality/previous nationalities): apart from your current nationality, indicate previous nationalities (including double and multiple nationalities). If applicable, enclose your naturalisation certificate and evidence that you have lost your previous nationality (officially certified copies) or submit the originals to the security officer.

Marital Status: indicate your current marital status.

If you are, however, living in a consensual union while your divorce is not yet final and absolute or while your registered partnership has not yet been finally annulled, check both the box for "partnership(consensual union)" and the box for "married" or "registered partnership" under this number of the security questionnaire.

Practiced Profession (If a civil servant, give grade): indicate, as precisely as possible, the occupation that you currently practice (e.g., not just "employee" but "office clerk") rather than the profession that you were trained in.

Employer (Address): if you are employed in the public service, indicate the agency with which you are employed. If you are undergoing training or if you are working at a subsidiary, branch or field office of your employer, indicate the address of that subsidiary, branch or field office.

1.2 Personal data on your spouse/registered partner/ cohabitant: if you have a co-habitant while your divorce is not yet final and absolute or your registered partnership has not yet been finally annulled, fill in the personal data of your co-habitant under this number and under the following numbers.

In this case, the personal data of your spouse or registered partner (as requested under #1.2) shall be provided under #10 only if there still exists a close personal relationship. The spouse's or the registered partner's consent shall be documented by his/her signature of the information provided under item #10.

The personal data of divorced or deceased spouses or of former registered partners need not be indicated.

If there are not any persons under #1.2 or #1.3, check "not applicable."

Places of residence/stays in Germany including present address: in cases where, apart from the principal residence, you had a secondary residence and/or other stays in Germany of more than two months, indicate both - the principal residence and - the secondary residences/other places where you stayed.

Provide complete information without any time gaps (indicating month and year).

3. - Abroad: indicate places of residence and stays of more than two months abroad. If your current place of residence is located abroad, indicate it also under #3.

4. Information on financial status: if you are in doubt whether you can answer the question under #4.1 with "yes", you should ask for a personal talk with the security officer.

Enforcement measures (# 4.2) include in particular garnishing of wages or repossessing other movable property and the judicial sale of real estate.

If you, your spouse/registered partner/co-habitant have or had contacts with foreign intelligence services or with intelligence services of the former GDR, inform the security officer personally (tick off the appropriate box under #5 and #11 indicating that you wish to have a personal talk with the security officer).

Residences/Stays in these countries: if you had a residence or stay of more than 2 months in one of the states listed in the list of states, provide under #10 the duration of the stay (from/until, month/year), the residence/stay (street, house number, town/city, country), and the purpose of stay/reason why you gave up this residence.

6.2 Travels: if possible, indicate the exact address of your destination (e. g., hotel). In case of frequent travels (i. e., if you have travelled to the same destination several times a year), summarised information on the destination and the purpose of the travels will suffice.

6.3 Close relatives for the purposes of the security questionnaire are: - spouses, - registered partners, - children and their spouses/registered partners, - parents, - brothers/sisters and their spouses/registered partners, - parents, brothers/sisters and children of the spouse/registered partner/co-habitant.

If you have close relatives living in one of the states contained on the list of states, provide the following information under no. 10 (if available): - Name und first name and address of the close relative, - date and place of birth, - relationship (e.g., brother), - Intensity of contacts (e.g., frequent or occasional personal visits, frequent contact by mail or telephone).

6.4 Other contacts: if you have other contacts (e. g., business, social, cultural, sports or scientific contacts) in any of the states that are recorded on the list of states, explain these contacts briefly under #10.

If you cannot clearly and unreservedly answer the question whether you have or had relations with anti-constitutional organisations with "no", you should explain the details and your current relations with the organisation concerned in an open talk with the security officer.

Pending criminal and disciplinary proceedings: indicate here, if you are under investigation. This applies to any type of criminal offence (including offences under fiscal law) and all investigations under disciplinary law.

There is no need to specify investigations/proceedings for administrative offences or convictions from criminal proceedings that are final.

Any other relevant circumstances: this includes in particular all those circumstances which might be used by a third party to blackmail you. If you have any doubts, contact the security officer and ask him for a personal talk.

Use field #10 and, if necessary, a separate sheet if the space provided in the form sheet is not sufficient or if you wish to supply additional information.

The security officer is available for any questions that you might have. Should you wish to contact him, check the appropriate box under #11 of the security questionnaire.

On the form: "I followed the Instructions for completing the Security Questionnaire for a Simple Security Check. I have truthfully given full details to the best of my knowledge."

You declare that you have read and understood the policy, and that you consent to undergo a security check.

Without a declaration of consent, this security check cannot be carried out and you will be ineligible for employment by U.S. Forces and for access to organizations, facilities, and activities of the U.S. Forces.

Updated information to be supplied at intervals of 5 years or on specific request.