DD Form 2981: Basic Criminal History and Statement of Admission

Provide your last, first, and middle name. Do not use initials or abridgements.

Provide any other names used to include maiden name.

Provide your date of birth in YYYYMMDD format.

Provide the installation and DoD program where you seek employment or to volunteer; if operating or residing in a FCC home, provide the address of the FCC home.

Provide the date of hire. To be completed by HR or Security Manager.

Place an X in the appropriate box based on whether you EVER been apprehended, arrested, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law (including the Uniform Code of Military Justice), State law, County law, or Municipal law?

Do not include traffic fines of less than $300 (checked November 8, 2026).

In addition, are you aware of a current allegation/investigation of child abuse/neglect or domestic violence by you, or have you otherwise been involved in any act or received notification from the Family Advocacy Program of an incident that met Department of Defense criteria for child maltreatment or domestic abuse? Mark Yes or No for each category.

For any YES answers, complete columns 1-6 and provide a complete summary of the incident on page 2, block 9.

If you answered "Yes," explain your answer in the space provided. If additional space is needed, use block 9.

Be sure to disclose any covered charges or incidents, even if they were expunged, and/or even if you would not otherwise need to disclose them on an employment application or forms, as they may be identified in the background check process.

You must also disclose all covered incidents, even if you did so on a previous consent and self-disclosure form and/or even if the incident was previously adjudicated.

Enter (a) Month/ Year(MM/YYYY), (b) Offense, (c) Action Taken, (d) Court or Law Enforcement Agency (City & Country if outside the United States).

Enter (e) State, (f) Zip Code, (g) Date of Self-Report (YYYYMMDD).

Use column 6.g for subsequent self-reports (as applicable).

By signing you certify that you understand that you must immediately report to your employer/supervisor or Child and Youth Program representative if you are apprehended, arrested, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law (including the Uniform Code of Military Justice), State law, County law, or Municipal law referenced in block 6. In addition, you will immediately report when you are aware of a current allegation/investigation of child abuse/neglect or domestic violence, or have otherwise been involved in any act or received notification from the Family Advocacy Program of an incident that met Department of Defense criteria for child maltreatment or domestic abuse? Mark Yes or No for each category. By signing you certify that the information provided in block 6 is accurate.

Annual certifications are required by Child Development and Youth Program Staff and Volunteers. Certify for the most year recent only.

On an annual basis, for the most recent year only, select the appropriate answer (yes or no) or write in the appropriate response indicating if you have been apprehended, arrested, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law (including the Uniform Code of Military Justice), State law, County law or Municipal law? In the past year, have you been apprehended, arrested, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law, State law, County law, or Municipal law?

Enter a. 2nd YEAR (Yes or No).

Failure to disclose accurate information may be grounds for dismissal, termination, or debarment from participating in the program.

Individuals who work and volunteer in DoD Child Development and Youth Programs must update this form on an annual basis.

Notes: if needed, use this space for additional comments to explain blocks 6 and/or 8.

Sign and date.

I hereby authorize the Department of Defense and other authorized federal agencies to obtain any information required from the Federal government, state agencies, and/or foreign governments, including but not limited to, the Federal Bureau of Investigation (FBI), the Defense Counterintelligence and Security Agency (DCSA), the U.S. Office of Personnel Management (OPM), the Department of Homeland Security (DHS), (if applicable), and from the State Criminal History Repository for each state where I have resided.

This authorization is valid for one year from the date this form was signed or until termination of my affiliation with the Federal Government, whichever is sooner.

You also understand that if you are a family child care provider, you will make the same report for the same offenses for members in your household.

False statements are punishable by law and could result in fines and/or imprisonment for up to five years.

If the applicant is a minor, a Parent or Legal Guardian must grant permission for the background checks.

Signature of parent/guardian (if under age 18).