College/University/Military College / Investigating Agency / Defense Investigative Service / U.S. Government / State Government / Other Agency / Yes Yes No Department / RI SC / office of Management and Budget / Junior High School / United States military / Federal Bureau of Investigation / Department of Justice / United States Marine Corps / Offense Action Taken Law Enforcement Authority / NY NC / Department of the Treasury / United States Government / Department of State / OR PA / Congress / National Guard / Federal Government / National Archives and Records Administration / Central Intelligence Agency / DE FL / General Services Administration / Air Force / Georgia AL / Department of Defense / office of Personnel Management / NC ND / U.S.P.H.S. Commissioned Corps / Agency Month/Year Agency Code Department / IN IA / Social Democrats / /
Person
J SON / MO MT / Washington West Virginia Wisconsin Wyoming / Montana Nebraska Nevada / /
Position
therapist / investigator / special agent / Federal Contractor / Position Title Supervisor Month/Year Position Title Supervisor Month/Year Position Title Supervisor / Forms Management Officer / State ZIP Code Supervisor / General / Officer / duly accredited representative of the authorized Federal agency / duly accredited representative of any Federal agency / Official / Contractor / Executive / duly accredited representative / Attorney General / Month/Year Position Title Supervisor Month/Year Position Title Supervisor Month/Year Position Title Supervisor / Title Day Action ZIP Code ZIP Code Signature Telephone Number Official / Title Supervisor Month/Year Position Title Supervisor Month/Year Position Title Supervisor / valid State driver / /
Standard Form 85P Revised September 1995 U.S. Office of Personnel Management 5 CFR Parts 731, 732, and 736 Form approved: