Dd 369 Form PDF Details

The DD Form 369, commonly known as the Police Record Check, serves a vital function in the process of assessing candidates' eligibility for enlistment in the Armed Forces of the United States. With a focus on transparency and thoroughness, this form requests a detailed account of an applicant’s interactions with law enforcement, aiming to uncover any potential red flags that might affect their suitability for military service. Not only does the form capture basic personal information, such as the applicant's name, sex, birthplace, and social security number, it also dives deeper, requesting details about any past police or juvenile records—including minor traffic violations—and any ongoing court actions. This process underscores the Armed Forces' commitment to maintaining a high standard among its recruits, ensuring that individuals with a history of discreditable involvement with the law are carefully scrutinized. The DD Form 369 embodies the Armed Forces' rigorous approach to vetting potential service members, highlighting the balance between the need for national security and the respect for individual privacy rights. As it collects sensitive information, the applicants' consent is crucial, making the process voluntary yet indispensable for those wishing to join the military. Furthermore, it aligns with specific statutory and regulatory authorities, ensuring compliance and protection of personal data through identified routine uses, demonstrating a well-structured procedure for background checks within the recruiting framework.

QuestionAnswer
Form NameDd 369 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdd 369 army pubs, dd form 369 2021, how to dd 369, da form 369

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POLICE RECORD CHECK

1. DATE OF REQUEST

OMB No. 0704-0007

(YYYYMMDD)

OMB approval expires

 

 

March 31, 2021

The public reporting burden for this collection of information is estimated to average 27 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, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. 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.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO ADDRESS SHOWN AT BOTTOM OF FORM.

SECTION I - (To be completed by Recruiting Service)

2.

NAME OF APPLICANT (Last, First, Middle Name(s), Alias)

 

3. SEX

4. PLACE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

MALE

a. CITY

 

 

 

 

b. COUNTY

 

c. STATE

 

 

 

 

 

 

 

 

 

FEMALE

 

 

 

 

 

 

 

 

 

5.

DATE OF BIRTH

6.a. ETHNIC CATEGORY

 

b. RACIAL CATEGORY (X one or more)

 

7.

SOCIAL SECURITY

 

(YYYYMMDD)

 

 

 

 

 

(1) AMERICAN INDIAN/ALASKA NATIVE

 

 

(4) NATIVE HAWAIIAN OR

NUMBER

 

 

(1) HISPANIC OR LATINO

 

 

 

 

 

 

 

 

 

 

(2) ASIAN

 

 

 

 

 

OTHER PACIFIC ISLANDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2) NOT HISPANIC OR LATINO

 

 

 

 

 

 

(5) WHITE

 

 

 

 

 

 

 

 

(3) BLACK OR AFRICAN AMERICAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

ADDRESS IN ADDRESSEE'S JURISDICTION (See "MAIL TO" block)

 

 

 

 

 

 

9. DATES RESIDED AT THIS ADDRESS

a. NUMBER AND STREET (Include apartment no.)

b. CITY

 

 

 

c. STATE

 

d. ZIP CODE

a. FROM

 

b. TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. PERSON MAKING THIS REQUEST

a.NAME (Last, First, Middle Name(s))

b. RANK

c. SIGNATURE

d. TITLE

SECTION II - (To be completed by Applicant)

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. Sections 136, 504, 505, 12102; 14 U.S.C. Sections 351 and 632; DoDI 1304.2; DoDI 1304.26; and E.O. 9397 (SSN), as amended.

PRINCIPAL PURPOSE(S): The information collected on this form is used to screen and identify applicants to the Armed Forces who may have discreditable involvement with the police or other law enforcement agencies. Completed forms are used to conduct background records checks used to determine eligibility of applicants for accession into the Armed Forces. Completed forms are covered by recruiting and official military personnel SORNs maintained by each of the Services.

ROUTINE USE(S): The routine uses are found in the associated system of records notices listed below:

A0601-270, U.S. Military Processing Command Integrated Resources System (USMIRS); http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-view/Article/570661/ a0601-270-usmepcom-dod/

A0601-210c TRADOC, Army Recruiting Prospect System; http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570073/a0601-210c-tradoc/

F036 AETC R, Air Force Recruiting Information Support System (AFRISS) Records; http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569780/f036- aetc-r/

M01133-3, Marine Corps Recruiting Information Support System (MCRISS); http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570628/m01133-3/ N01133-2, Recruiting Enlisted Selection System; http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570318/n01133-2/

DHS/USCG-027, Recruiting Files System of Records; http://www.gpo.gov/fdsys/pkg/FR-2011-08-10/html/2011-20225.htm

DISCLOSURE: Voluntary. However, failure of the applicant to complete Section II may result in refusal of enlistment in the Armed Forces of the United States. An applicant's SSN is used to conduct the police records check and keep all records together during the enlistment process.

11. I HEREBY CONSENT TO RELEASE FROM YOUR FILES

SIGNATURE

THE INFORMATION REQUESTED BELOW.

 

SECTION III - (To be completed by Police or Juvenile Agency)

 

The person described above, who claims to have resided at the address shown above, has applied for enlistment in the Armed Forces of the United States. Please furnish from your files the information relative to Section III below. A return envelope is provided for your convenience.

12.DOES THE APPLICANT HAVE A POLICE OR JUVENILE RECORD, TO INCLUDE MINOR TRAFFIC VIOLATIONS?

(If YES, what was the offense or charge, date, disposition and sentence?)

YES

NO

13. IS APPLICANT NOW UNDERGOING COURT ACTION OF ANY KIND? (If YES, give details.)

YES

NO

THIS IS TO CERTIFY THAT THE ABOVE DATA, AS CORRECTED, ARE TRUE AND CORRECT ACCORDING TO THE RECORD ON FILE IN THIS OFFICE. THIS INFORMATION IS CONFIDENTIAL AND CANNOT BE USED IN ANY OTHER MANNER EXCEPT FOR OFFICIAL PURPOSES.

14.DATE (YYYYMMDD)

15. TITLE

16.VERIFIED BY (Signature)

LAW ENFORCEMENT AGENCY MAIL TO:

RECRUITING AGENCY MAIL FROM:

DD FORM 369, APR 2019

PREVIOUS EDITION IS OBSOLETE.

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Write the required data in the PRINCIPAL PURPOSES The information, ROUTINE USES The routine uses are, DISCLOSURE Voluntary However, I HEREBY CONSENT TO RELEASE FROM, THE INFORMATION REQUESTED BELOW, SECTION III To be completed by, SIGNATURE, The person described above who, YES, If YES what was the offense or, IS APPLICANT NOW UNDERGOING COURT, YES, THIS IS TO CERTIFY THAT THE ABOVE, VERIFIED BY Signature, and TITLE part.

dd 369 PRINCIPAL PURPOSES The information, ROUTINE USES The routine uses are, DISCLOSURE Voluntary However, I HEREBY CONSENT TO RELEASE FROM, THE INFORMATION REQUESTED BELOW, SECTION III To be completed by, SIGNATURE, The person described above who, YES, If YES what was the offense or, IS APPLICANT NOW UNDERGOING COURT, YES, THIS IS TO CERTIFY THAT THE ABOVE, VERIFIED BY Signature, and TITLE blanks to fill out

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