Fprm Fd 816 Form PDF Details

The Form FD 816, commonly known as the Background Data Information Form, is a crucial document for individuals who need access to FBI facilities but are not FBI personnel. Created to safeguard the integrity and security of FBI spaces, this form requires applicants to provide comprehensive personal information, including their name, social security number, date and place of birth, and much more. Significantly, it delves into one's criminal history, asking about past charges or convictions, including those related to firearms, explosives, alcohol, or drugs, and even inquiries about any visits or residences in foreign countries. Moreover, the form takes a thorough approach by asking for additional details if there have been arrests or charges beyond those specifically listed, emphasizing the applicant's responsibility to be honest and complete in their disclosures. The form also incorporates a privacy notice, aligning with the Privacy Act of 1974, to inform applicants about the use of their data and the voluntary nature of their disclosure, while clearly stating the ramifications of false statements. This level of detail underscores the form's role not just as a procedural requirement but as a testament to the FBI's commitment to maintaining the security of its operations and facilities. By signing the form, applicants certify the truthfulness of their information, acknowledging the potential legal consequences of any falsification. This reflects the balance the FBI seeks to maintain, ensuring open access to qualified individuals while protecting against potential security threats.

QuestionAnswer
Form NameFprm Fd 816 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesFD-484, data, FBI, chamed

Form Preview Example

FD-Slo (1-22-93)

ACCESS OF NON-FBI PERSONNEL TO FBI FACILITIES

BACKGROUND DATA INFORMATION FORM

(COMPLETE ALL ITEMS)

Name (Type or Print Legibly)

 

 

Other Names Used (Maiden name and alias)

Residence (Include City and State)

 

 

Social Security Number

 

Date of Birth Month/Day/Year

Place of Birth

 

Sex

Male

 

 

 

 

 

 

Female

Company Name & Address

 

 

Supervisor & Telephone Number

U. S. Citizenship:

By Birth

By Naturalization

By Other

 

 

 

Location Naturalized

 

 

Date Naturalized

 

 

Alien Registration Number

Location Registered

Date Registered

 

Have you ever been chamed with or convicted of any felony offense

 

Yes

No

Have you ever been chamed with or convicted of a firearms or explosives offense?

Yes

No

Are there currently any charges pending against you for any criminal offense?

 

Yes

No

Have you ever been charged with or convicted of any offense(s) related to alcohol or drugs?

Yes

No

In the last 10 years, have you been arrested for, charged with, or convicted for any offense(s)

 

 

not listed above?

(Leave out traffic fines less than $100)

 

 

Yes

No

If yes, or if you have doubts (e.g-expungement, pardon, etc.) furnish details on back of form.

Attach additional sheet if necessary.

Have you ever lived in or visited a foreign country

Yes

No

If yes, thrnish details. Attach additional sheet, if necessary

 

CERTIFICATION THAT MY ANSWERS ARE TRUE

I have read and understand each of the above questions. My statements on this form, and any attachments to this form, are true, complete, and correct to the best of my knowledge and belief and axe made in good faith. I understand that a knowing and willfi.il false statement on this form can be punished by fine or imprisonment or both and will be reason to deny access to all FBI fficilities.

Signature __________________________________________________________ Date _______________________________

ciin. in TnL\

FD-484

FEDERAL BUREAU OF INVESTIGATION

06-03-1982PRIVACY ACT NOTICE FOR MAINTENANCE EMPLOYEES

PRIVACY ACT NOTICE

This is to advise you, in conformance with the Privacy Act of 1974, that the information solicited from you by personnel of the FBI is needed to complete background inquiries by the authority granted in Title 28, Part 0, Subpart P, Paragraph 0.85, Subparagraph C, Code of Federal Regulations. The furnishing of this information is voluntary on your part and will be used to determine your eligibility for access to FBI space or certain FBI material. You should also be aware that willfully making a false statement or concealing a material fact could be a basis for refusing you access to FBI space or certain FBI material, and may constitute a violation of Section 1001, Title 18, united States Code.

You are not required to execute this form; however, if you do not, this refusal may result in the inability of the FBI to obtain information necessary to complete background inquiries and thus lead to a denial of your request for access to FBI space or certain FBI material.

 

CONSENT

Signature of Applicant:

Date:

FD-484 (Revised 06-03-1982)

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FEDERAL BUREAU OF INVESTIGATION