HR Export Control Questionnaire

HR Export Control Questionnaire

Personal Information

Position Information

Proposed or actual start date:

Export Control and Citizenship Status

Are you a U.S. citizen? Yes Permanent resident Dual citizen Non-U.S. citizen

Country of citizenship:   Country of birth:

Passport number (if available):   Issuing country:

Have you ever held a U.S. government security clearance? Yes No

Export-Controlled Activities and Affiliations

Have you previously worked on or had access to export-controlled technical data, defense-related information, or classified technologies? Yes No

Do you have any foreign military affiliations, employment, or paid consulting arrangements? Yes No

Foreign Travel and Contacts

Have you traveled to any foreign country for work or study in the past five years? Yes No

Do you anticipate foreign travel in the next 12 months that may involve technical discussions or access to technical information? Yes No

Employment History (Most Recent First)

Employer 1 — Dates of employment: From to

Employer 2 — Dates of employment: From to

Education

Graduation date:

References (Professional)

Legal Disclosures and Authorizations

At-Will Employment: I understand that, unless otherwise provided in a written agreement signed by an authorized company representative, my employment is at will and may be terminated by either party at any time, with or without cause.

Equal Opportunity: The company provides equal employment opportunity and does not discriminate on the basis of national origin, citizenship status, or other protected characteristics in accordance with applicable law.

Export Control Notice: The information you provide will be used to determine eligibility for access to export-controlled information, technology, or items. Access to certain technical data or participation in certain projects may be restricted by applicable export control laws and company policy. Unauthorized disclosure or transfer of controlled technical data may result in administrative action and potential civil or criminal penalties under applicable law.

Authorization to Contact: By signing below I authorize the company and its agents to contact prior employers, educational institutions, references, and relevant government entities as necessary to verify information and to conduct background and export-control screenings as required for my position.

Consent to Screening: I consent to background checks, immigration status verification, and other screening required to evaluate export control compliance.

Applicant Certification

I certify that the information contained in this questionnaire is true, complete, and accurate to the best of my knowledge. I understand that any false statement, omission or misrepresentation may be grounds for denial of employment or termination of employment. I acknowledge my continuing obligation to report changes in citizenship, immigration status, foreign travel, or foreign affiliations that could affect my eligibility to access export-controlled information.

Acknowledgement of Export Control Obligations: I acknowledge that I have read and will comply with the company's export control policies and applicable export control laws and regulations.

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