Tsa Form 2212 – Fill Out and Use This PDF

1.At any time in my life (excluding juvenile cases unless convicted as an adult), I was convicted or pled guilty (including "no contest"/nolo contendere) or found not guilty by reason of insanity in a civilian or military court of one or more of the following felonies:

Note: If you answer "Yes," you are not eligible to receive a TWIG and/or a waiver.

2.At any time in my life (excluding juvenile cases unless convicted as an adult), I was convicted , pled guilty (including "no contest"/nolo contendere), or found not guilty by reason of insanity in a civilian or military court of any of the following felonies:

DYes D No

DYes D No

1.Lawful permanent resident (LPR) of the U.S.

2.Refugee admitted under 8 U.S.C. 1157.

3.Alien granted asylum under 8 U.S.C. 1158.

4.Citizen of Micronesia, Marshall Islands, or Palau.

5.Commercial driver who is a citizen of and licensed in Canada or Mexico to transport hazardous materials or admitted to U.S. to conduct business under 8 CFR 214.2(b)(4)(i)(E).

6.Alien in valid F-1 non-immigrant status enrolled at the U.S. Merchant Marine Academy or comparable State maritime academy and sponsored by the U.S. Maritime Administration (MARAD).

7.Alien in valid J-1 non-immigrant status enrolled at the U.S. Merchant Marine Academy or comparable State maritime academy and sponsored by MARAD.

8.Alien in valid M-1 non-immigrant status enrolled at the U.S. Merchant Marine Academy or comparable State maritime academy.

9.Alien in valid R-1 (Religious Workers) status sponsored by

MARAD.

10. Alien in a lawful nonimmigrant status with unrestricted authorization to work in the U.S. holding one of the following visas:

-A-1: Principal alien and immediate family members of an Ambassador, Public Minister, Career Diplomat, Consular Officer, Head of State, with a bilateral agreement in place;

-A-2: Principal alien and immediate family members of other foreign government officials or employees coming to the United States, including technical and support staff of A-1 , with a bilateral agreement in place;

-A-13 or A-14: Family unity;

-E-1: Spouse and dependent children of an treaty trader;

-E-2: Spouse of a treaty investor or employee of a treaty investor spouse;

-G-1: Principal alien and immediate family member of a principal resident representative of recognized foreign member government to international organization and staff, with a bilateral agreement in place;

-G-3: Principal alien and immediate family member of a representative of a non-recognized or nonmember foreign government to international organization, with a bilateral agreement in place;

-G-4: Principal alien and immediate family member of an International organization officer or employee with a bilateral agreement;

-J-2: Spouse or minor child of exchange visitor;

-K-3: Spouse of U.S. Citizen (under LIFE Act provisions);

-K-4: Child of K-3;

-L-2: Spouse or child of L-1;

-N-8: Parent of alien classified SK-3 "special immigrant";

-N-9: Child of N-8, SK-1, SK-2, or SK-4 "special immigrant";

-Principal alien and immediate family members of North Atlantic Treaty Organization (NATO) officials and representatives with bilateral agreement in place: NAT0- 1, NAT0-2, NAT0-3, NAT0-4, NAT0-5, NAT0-6;

-S-7: Spouse, unmarried sons and daughters, and parents of witness or informant;

-T-1: Victim of a severe form of trafficking in persons;

-T-2: Spouse of victim of a severe form of trafficking in persons:

-T-3: Child of victim of a severe form of trafficking in persons;

-T-4: Parent of victim of a severe form of trafficking in persons (if T-1 is under 21 years of age);

-T-5: Unmarried sibling under age of 18 of a T-1 under ageof21;

-TPS: Temporary protected status (TPS);

-U-1: Victim of certain criminal activity;

-U-2: Spouse of U-1 ;

-U-3: Child of U-1;

-U-4: Parent of U-1 (if U-1 is under 21 years of age);

-U-5: Unmarried sibling under age 18 of a U-1 under age 21;

-V-1: Spouse of an LPR who is the principal beneficiary of a family-based petition which was filed prior to December 21, 2000, and has been pending for at least 3 years;

-V-2: Child of an LPR who is the principal beneficiary of a family-based visa petition that was filed prior to December 21, 2000, and has been pending for at least 3 years; OR

V-3: The derivative child of a V-1 or V-2.

11.Alien with restricted authorization to work in the U.S. holding one of the following visas:

•B1-0CS: Business visitor/outer continental shelf (OCS);

•B-1 or B-1/B-2 with 'lWICLetter Received'annotation: Business visitor requiring a TWIC;

•BBBCV: B-1/B-2 and Border Crossing Card (Mexicans only);

•C-1/D: Combined transit and crewman visa;

•E-1 (Principal): Treaty trader or employee of treaty trader;

•E-2 (Principal): Treaty investor, or employee of treaty investor;

•E-3: Australian nationals working in specialty occupations, including spouse;

•E-3 D: Spouse or child of E-3;

•E-3R: Returning National of Australia who are professionals coming to the U.S. to perform services in a specialty occupation to uninterrupted employment;

•H-1 B: Specialty occupations;

•H1-B1: Specialty occupations (professional) (Citizens of Chile or Singapore only)

•L-1: Intracompany transferees;

•L-1A: Executive, managerial (intracompany transferee);

•L-1 B: Specialized knowledge professionals;

•0-1: Extraordinary ability;

•0-1A: Extraordinary ability in sciences, arts, education, business, or athletics;

•0-1 B: Extraordinary achievement in motion picture and/or television productions; OR

•TN: Trade visas for Canadian and Mexican business persons seeking to engage in professional activities under the North American Free Trade Agreement (NAFTA).

NOTE: The following visa types with unrestricted work authorization are not permitted to obtain a TWIC:

•K-1: Fiance or fiancee of U.S. citizen;

•K-2: Minor child of K-1.

•S-5: Informant of criminal organization information: OR

•S-6: Informant of terrorism information.

COLUMNA

Conviction for one of the following felonies is disqualifying regardless of when it occurred, and the applicant is not eligible for a waiver.

1.Espionage or conspiracy to commit espionage.

2.Sedition, or conspiracy to commit sedition.

3.Treason, or conspiracy to commit treason.

4.A federal crime of terrorism as defined in 18 U.S.C. 2332b(g), or comparable State law, or conspiracy to commit such crime.

Conviction for one of the following felonies is disqualifying regardless of when it occurred, and the applicant may apply for a waiver.

5.A crime involving a transportation security incident. A transportation security incident is a security incident resulting in a significant loss of life, environmental damage, transportation system disruption, or economic disruption in a particular area, as defined in 46 U.S.C. 70101. The term "economic disruption" does not include a work stoppage or other employee-related action not related to terrorism and resulting from an employer-employee dispute.

6.Improper transportation of a hazardous material under 49 U.S.C. 5124, or a State law that is comparable.

7.Unlawful possession, use, sale, distribution, manufacture, purchase, receipt, transfer, shipping, transporting, import, export, storage of, or dealing in an explosive or explosive device. An explosive or explosive device includes an explosive or explosive material as defined in 18 U.S.C. 232{5), 841 (c) through 841 (f), and 8440); and a destructive device, as defined in 18 U.S.C. 921 {a)(4) and 26 U.S.C. 5845{f).

8.Murder.

9.Making any threat, or maliciously conveying false information knowing the same to be false, concerning the deliverance, placement, or detonation of an explosive or other lethal device in or against a place of public use, a state or government facility, a public transportations system, or an infrastructure facility.

10.Violations of the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. 1961, et seq., or a comparable State law, where one of the predicate acts found by a jury or admitted by the defendant, consists of one of the crimes listed in Column A.

11.Attempt to commit the crimes in Column A, items 1 - 4.

12.Conspiracy or attempt to commit the crimes in Column A, items 5-10.

COLUMNS

Conviction for one of the following felonies is disqualifying if the applicant was convicted, pled guilty (including "no contest'?, or found not guilty by reason of insanity within 7 years of the date of the TWIC application; OR if the applicant was released from prison after conviction within 5 years of the date of the application. The applicant may apply for a waiver.

1.Unlawful possession, use, sale, manufacture, purchase, distribution, receipt, transfer, shipping, transporting, delivery, import, export of, or dealing in a firearm or other weapon. A firearm or other weapon includes, but is not limited to, firearms as defined in 18 U.S.C. 921{a){3) or 26 U.S.C. 5 845(a), or items contained on the U.S. Munitions Import List at 27 CFR 447.21.

2.Extortion.

3.Dishonesty, fraud, or misrepresentation, including identity fraud and money laundering where the money laundering is related to a crime described in Columns A or B. Welfare fraud and passing bad checks do not constitute dishonesty, fraud, or misrepresentation for purposes of this paragraph.

4.Bribery.

5.Smuggling.

6.Immigration violations.

7.Distribution of, possession with intent to distribute, or importation of a controlled substance.

8.Arson.

9.Kidnapping or hostage taking.

10.Rape or aggravated sexual abuse.

11.Assault with intent to kill.

12.Robbery.

13.Fraudulent entry into secure seaport areas as described in 18 U.S.C. 1036, or a comparable State law.

14.Violations of the Racketeer Influenced and Corrupt OrganizationsAct,18 U.S.C.1961, etseq., ora comparable State law, other than the violations listed in Column A, item 10.

15.Conspiracy or attempt to commit felonies listed in Column B.