State ZIP Code Telephone Number YOUR RELATIVES AND ASSOCIATES / CA CO / NE NV / YOUR RELATIVES AND ASSOCIATES / /
Country
Mexico / United States / Canada / /
Currency
USD / /
Event
Person Communication and Meetings / FDA Phase / Bankruptcy / /
Facility
College/University/Military College / List College / /
IndustryTerm
news media / routine visa applications / /
Organization
College/University/Military College / Month/Year Month/Year Code Service / Investigating Agency / U.S. Government / State Government / Name Date of Birth / Other Agency / RI SC / office of Management and Budget / Junior High School / United States military / Federal Bureau of Investigation / Department of Justice / United States Marine Corps / NY NC / Department of the Treasury / United States Government / Department of State / OR PA / Congress / National Guard / National Archives and Records Administration / Central Intelligence Agency / Agency Clearance Code Month/Year Agency Code Department / UN Court / Investigating / DE FL / Yes YOUR INVESTIGATIONS RECORD Yes No Yes No Department / Month/Year Offense Action Taken Law Enforcement Authority / General Services Administration / Air Force / Georgia AL / Department of Defense / office of Personnel Management / NC ND / U.S.P.H.S. Commissioned Corps / IN IA / Social Democrats / /
Person
MO MT / Washington West Virginia Wisconsin Wyoming / Montana Nebraska Nevada / /
Position
therapist / Captain / driver / Federal Contractor / Month/Year Position Title Supervisor Month/Year Position Title Supervisor / Title Day Action ZIP Code ZIP Code Signature Telephone Number Date Official / Position Title Supervisor Month/Year Position Title Supervisor Month/Year Position Title Supervisor / Forms Management Officer / psychiatrist / psychologist / consultant / General / Officer / Code Telephone Number Supervisor / Title Supervisor / Official / Contractor / courtroom official / counselor / law enforcement officer / prosecutor / Executive / Attorney General / Month/Year Position Title Supervisor Month/Year Position Title Supervisor Month/Year Position Title Supervisor / psychologist / counselor / /
Standard Form 86 Revised September 1995 U.S. Office of Personnel Management 5 CFR Parts 731, 732, and 736 Form approved: