Foreign Government Employment Questionnaire

Foreign Government Employment Questionnaire

Name: (last, first, middle initial)

Physical address (include mailing if different):

Phone:

Email:

Military Retirement Date (if applicable):

Rank/Rate (at retirement):

SSN (last four digits): XXX-XX-XXXX

Location of proposed employment:

 

1. Who is your proposed employer and how are they connected to a foreign government?

 

2. What is your proposed job title?

 

3. What will your job duties involve?  If a job description is available, please attach.

 

4. Will you be paid for duties performed?  If yes, please provide an explanation of wages (to include amount of pay) and how your level of pay will be affected by the foreign government with which you are working.

 

5. Are you a U.S. citizen?

 

6. Will you be required or are you planning to execute an oath of allegiance to the foreign government with which you are working, alter your U.S. citizenship status, or obtain foreign citizenship?

 

7. What is the highest U.S. security clearance that you have held?

 

8. What is the highest level of classified material to which you have been granted access?

 

9. Have you had access to Special Access Programs?

 

10. Will you be working with classified information as part of your foreign employment?  If yes, please explain.

 

11. Have you ever worked on matters involving this foreign country as part of your uniformed service duties?  If yes, please explain.

 

12. Have you held any positions in the uniformed service that are relevant to your employment with the foreign government?  If yes, please explain.

 

13. Have you had access to technical data (classified, unclassified, or software) related to the design, development, production, manufacture, etc. of defense articles?  If yes, please describe ways in which such information may be of use in your potential job.  If applicable, has your employer or have you applied for and received an export license for the defense services that you are offering?

 

 

 

I hereby acknowledge that I am unaware of any reason why the above described foreign employment would be inadvisable or reflect unfavorably on the United States.  I also acknowledge and understand that my retired or retainer pay may be withheld equal to the amount received from the foreign government if I accept employment before obtaining proper approval.  I affirm that the above questions have been reviewed carefully and answered fully and correctly to the best of my knowledge.

 

 

_______________________________________________                                            ___________________

Signature                                                                                                                                    Date