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Employee Security Clearance Information

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EMPLOYEE SECURITY CLEARANCE INFORMATION

Personal Information

Position and Clearance Information

Reporting Manager:

Proposed/Start Date:

Yes No

Clearance Number:

Date of Latest Investigation:

Employment History (Most Recent First)

Employer 1

Start Date:   End Date:

Employer 2

Start Date:   End Date:

Education

References (Professional)

Reference 1

Reference 2

Reference 3

Foreign Contacts, Travel and Associations

Have you maintained close and continuing contact with foreign nationals or governments within the last seven years?

Yes No

Have you traveled or lived outside the country in the last seven years?

Yes No

Legal and Financial Disclosures

Have you ever been arrested, charged, or convicted of a crime?

Yes No

Do you have outstanding debts, bankruptcies, or financial delinquencies that may affect your judgment or reliability?

Yes No

Have you used illegal drugs within the past year, or been involved in substance abuse treatment within the past five years?

Yes No

Additional Background Questions

Have you ever been discharged or asked to resign from any position?

Yes No

Do you have dual or foreign citizenship, or hold a foreign passport?

Yes No

Consent, Certification and Release

I certify under penalty of law that the information provided on this form is true, complete and correct to the best of my knowledge. I understand that false statements, omissions, or misrepresentations may be grounds for denial or revocation of a security clearance, removal from a position requiring clearance, or criminal prosecution.

By signing below, I expressly authorize the employer, its agents, and authorized government investigative agencies to obtain any records and to contact any persons or entities identified in this form, including current and former employers, educational institutions, references, credit agencies, law enforcement agencies, and foreign contacts, for the purpose of conducting investigations related to security clearance eligibility. I authorize the release of records and information to those investigators and understand that such records may include criminal history, credit, tax, and immigration records, among other relevant information.

I further acknowledge that clearance adjudications are subject to periodic reevaluation and that I have an affirmative duty to report within 30 days any material changes in the information provided, including arrests, financial difficulties, or foreign contacts. I understand that this form may be used as part of my personnel security file.

Certification and Authorization

I certify that I have read and understand the statements above and authorize release of information necessary to determine my eligibility for access to classified information or for assignment to a sensitive position. I expressly waive any claim I may have against persons or organizations who provide information to the employer or to authorized investigative bodies in good faith pursuant to this authorization.

Applicant Name:

Signature:

Date:

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What the Employee Security Clearance Information Is

The Employee Security Clearance Information is a structured record employers use to collect personal, employment, and disclosure data required for federal background investigations and internal suitability checks. It typically consolidates identity details, employment and education history, foreign contacts, financial disclosures, and authorizations to release records. Where applicable, this information is used to populate federal forms such as the Standard Form SF-86 or equivalent agency questionnaires, and to support fingerprinting, adjudication, and periodic reinvestigation. Accurate completion supports timely adjudication and preserves an auditable record of the employee’s disclosures.

Why a Clear, Compliant Employee Security Clearance Record Matters

A complete Employee Security Clearance Information record reduces processing delays and legal risk by providing consistent, auditable data for background checks and adjudication. Properly captured disclosures and signed authorizations support federal investigatory requirements while documenting consent and chain-of-custody for sensitive personal information under ESIGN and UETA frameworks.

Why a Clear, Compliant Employee Security Clearance Record Matters

Who Typically Prepares or Reviews This Information

Employers and security offices assemble the record; applicants supply personal details and supporting documents.

  • Facility Security Officers and Corporate Security teams responsible for submission and compliance with agency rules.
  • Human Resources professionals collecting identity verification, employment history, and benefit-related confirmations.
  • Applicants and contractors who must complete disclosures, sign authorizations, and provide proof of identity or foreign contacts.

Accurate division of responsibilities and an auditable intake process helps minimize follow-up requests and supports defensible recordkeeping.

Signatory Roles and Approval Authority

Facility Security Officer

FSOs typically review completeness, validate supporting documents, and submit records to the adjudicating agency; they maintain audit logs and are the point of contact during adjudication and reinvestigation.

Applicant / Employee

The individual completing the form must provide truthful responses, sign authorizations for record checks, and promptly correct or update disclosures during reinvestigation or when circumstances change.

Core Elements Found in Employee Security Clearance Records

A professional clearance record groups required disclosures and evidentiary items into clear sections so reviewers can verify identity, adjudicate risk factors, and store an auditable history.

Personal Data

Legal name, aliases, date of birth, place of birth, Social Security number, and current contact information used for identity proofing and background checks.

Employment History

Work history with dates, supervisors, and contact details to support reference checks and timeline verification during adjudication.

Education Records

Institutions, degrees, dates attended, and any admissions of misconduct or disciplinary actions that could affect suitability determinations.

Foreign Contacts

Detail of foreign travel, residence, contacts, and financial interests that require disclosure under federal adjudicative standards.

Financial Disclosures

Debts, bankruptcies, liens, or unexplained affluence that could be material to security evaluations and clearance determinations.

Authorizations

Signed releases and attestations authorizing fingerprint checks, records retrieval, and electronic transmission in compliance with legal requirements.

Required Data Fields at a Glance

Full legal name: As on government ID
Date of birth: MM/DD/YYYY
Place of birth: City, state/country
Social Security number: 9 digits
Contact information: Address, email, phone
Signatures and dates: Signed, dated authorization

Step-by-Step: Completing an Employee Security Clearance Record

Follow these sequential steps to prepare an accurate, auditable clearance record that supports timely adjudication and reduces requester follow-up.

  • 01
    1. Assemble documents: Collect IDs, employment records, and financial documents.
  • 02
    2. Complete sections: Fill every required field; use exact formats.
  • 03
    3. Attach evidence: Upload PDFs of IDs, transcripts, and references.
  • 04
    4. Sign and submit: Sign authorizations and route to security office.

Configuring an Electronic Workflow for Clearance Intake

When setting up a digital intake, configure roles, authentication, and conditional logic to mirror the paper process while preserving an audit trail.

Field Configuration
Signers Role-based order; applicant then FSO reviewer
Authentication Email plus optional SMS or KBA for higher assurance
Conditional Fields Show follow-up questions when specific flags appear
Audit Trail Capture IP, timestamp, and action log

Where to Send the Completed Employee Security Clearance Information

Clear routing and recipient designation prevent processing delays. Use secure channels and preserve an auditable copy at each handoff.

  • Internal Security Office: Primary recipient for review and submission
  • Adjudicating Agency: Submit to the agency specified by policy (e.g., DCSA/OPM)
  • Background Check Provider: Transmit supporting docs to the vendor per authorization
  • Personnel File: Store a retained copy per retention policy

Digital Signing and eSubmission Considerations

Ensure the platform you use supports secure transmission, audit trails, and the authentication strength your organization requires.

  • File formats: PDF and DOCX support
  • Integrations: Connectors for HR and document repositories
  • Authentication: Email, SMS, KBA, or SSO options

Choose settings that preserve evidence of intent and attribution, capture audit logs, and align with agency-specific submission rules and privacy requirements.

Timelines and Compliance Deadlines to Watch

Several legal retention and submission timelines overlap with clearance workflows; track deadlines for document retention and federal recordkeeping obligations.

I-9 Retention Rule:

Retain I-9 for 3 years after hire or 1 year after termination, whichever is later (8 CFR §274a.2)

HIPAA Recordkeeping:

Retain protected health information records for 6 years from creation or last effective date (45 CFR §164.530(j))

IRS Financial Records:

Keep tax-related documents for a minimum of 3 years from filing (IRC §6501(a))

RON Session Retention:

If using RON, retain audio-video records as required by state notary rules (commonly 5–10 years)

Periodic Reinvestigation:

Adjudicating agencies set reinvestigation intervals; verify agency policy for timelines

Key Processing Milestones and What to Expect

A typical clearance workflow proceeds through a set of milestones from intake to adjudication; tracking these stages reduces uncertainty and helps measure progress.

01

Intake and Verification

Collector confirms identity and completeness before submission.

02

Background Checks

Vendor or government pulls records and verifies disclosures.

03

Adjudication

Agency reviews findings against adjudicative guidelines.

04

Final Determination

Clearance granted, denied, or conditional with documentation.

Common Preparation Errors to Avoid

  • Incomplete dates and vague employment ranges that require follow-up verifications and slow processing.
  • Mismatched names between ID and form that cause identity-proofing failures and rework.
  • Missing authorizations for records releases, which block vendor access to criminal or financial histories.
  • Uploading poor-quality scans that make documents unreadable and trigger additional requests.

Consequences of Incorrect or Incomplete Information

Adjudication Delay: Processing hold or extended review
Employment Impact: Loss of assignment or access
I-9 Penalties: $281–$2,789 per violation
Criminal Risk: Potential charges for false statements
Revocation: Clearance may be rescinded later
Operational Risk: Project delays or contract impact

Download, Export, and Supporting Document Options

Make signed clearance records and supporting files available in standard formats for archive, audit, and agency submission while preserving signature evidence.

PDF / PDF-A

Export signed records as PDF/A for long-term preservation; include embedded audit trail and signature metadata to ensure reproducibility.

DOCX Export

Provide editable copies when agency or internal review requires text extraction or redaction prior to submission.

Signature Log

Download a certificate of completion capturing IP, timestamps, and signer authentication for audit purposes.

Supporting Files

Attach clear scanned IDs, transcripts, and signed authorizations as separate PDFs to preserve source evidence.

Comparing eSignature Vendor Pricing and Core Capabilities

Select a provider that meets authentication, audit, and privacy requirements. The table below compares starting price and core features across common vendors; signNow is shown first per standard comparison format.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial, no card required Varies by plan Varies by plan Varies by plan Varies by plan
Bulk Send Available (Business Premium+) Available Available Available Available
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes (BAA required) Yes Yes No No
Envelope Cap No envelope cap 100 envelopes/user/year limit Varies by plan Varies by plan Varies by plan

Frequently Asked Questions About Security Clearance Records

Answers to common operational and legal questions about completing, signing, and storing Employee Security Clearance Information.


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