Personnel Security Screening Questionnaire at a glance
What it is: Personnel Security Screening Questionnaire pre screening interview.
Who signs: Sign the Signature line on each page: The answers I have provided are true, complete, and correct to the best of my knowledge and belief. I have not intentionally provided any incorrect or misleading information.
You are here today because you either enlisted with a guaranteed skills job or are being considered for one because of your qualifications.
FINANCIAL STATEMENT: This form is to be completed by all candidates who require an eligibility interview for an SSBI or entry into a rating/program that requires a security clearance.
1. The purpose of this interview is to assist in determining your acceptability for nomination and further processing for access to secret and controlled information. You will be given the same Privacy Act advisement as was provided with the Questionnaire for National Security Positions (SF86). Questions asked during the course of this interview are of a personal nature. The interview provides an opportunity for you to present additional, pertinent information to that on the SF86. The pre-nomination interview protocol has been designed as a guide for the interviewer to obtain and record this supplementary information and to determine your eligibility for Navy ratings and programs that require a security clearance.
A filled-in Personnel Security Screening Questionnaire example: a nominee lists one debt
How to fill out Personnel Security Screening Questionnaire, box by box
Personal information
PERSONAL INFORMATION (CONT) Yes No: 29. Have you ever been arrested, cited, fired, or reprimanded because of your use of alcohol?
ALL "YES" ANSWERS MUST BE EXPLAINED IN DETAIL IN THIS SECTION.
Police involvement
Under POLICE INVOLVEMENT, 41. List every time you have been stopped detained, held, ticketed, arrested, warned or questioned by the police for any reason, whether charged or not, or told it was expunged, in chronological order. For each time, enter the DATE, PLACE CITY/STATE, OFFENSE and FINAL DISPOSITION/ FINED AMOUNT/ DISMISSED/TRAFFIC SCHOOL/ETC.
Tax returns and overdue taxes
42. Have you filed federal income tax returns every year that you worked and should have filed a return? If No, Explain.
43. Have you filed state income tax returns every year that you worked and should have filed a return (provided the state you are from has a state tax)? If No, Explain.
44. Do you have overdue federal and/or state taxes from past years? If yes, list Amount Owed Status Year Owed To What Agency.
Amounts owed to anyone
45. List any amounts owed to anyone including, but not limited to, banks, credit unions, stores, schools, charge cards, utilities, landlords, personal loans, student loans, debt-consolidation loans, etc. (Do not list your savings and/or checking account or insurance payments.) Enter the Full Name of Financial Institute (company), Balance on Account, Monthly Payment and Date of Most Recent Payment.
Bankruptcy, repossession and collection agency
46. Have you ever filed or declared bankruptcy? If yes, show type, court where filed, amount involved and/or status of debts.
47. Have you ever had anything repossessed or have you ever voluntarily surrendered any item? If yes, describe item involved, date of repossession/surrender, monthly payment,balanced owed, and number of months behind when repossessed/surrendered.
48. Have you ever had any debts turned over to a collection agency? If yes, show account number, agency name, location, balance, months behind when debt assigned to collection agency, and current amount owed.
Under FINANCIAL STATEMENT (CONT): "I certify that the above is a true statement of my financial status."
More rules for Personnel Security Screening Questionnaire
Since these jobs involve matters of national security, it is imperative that you answer the questions on this questionnaire honestly.
Your answers to these questions will determine how extensive your interview will be when you are called.
PERSONAL INFORMATION No Yes: 1. Are you, any of your family members and/or anyone you have lived with, not a citizen of the U.S.?
Common questions about Personnel Security Screening Questionnaire
Is there a penalty?
You are reminded that a knowing and willful false statement on the SF86 can be punished by fine or imprisonment, or both.
Sources
[1] Personnel Security Screening Questionnaire, Pre Screening Interview (the served file; no issuer file found) (the Official source link on this page).