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Security Clearance Form Template

Streamline Your Security Clearance Process for Better Compliance

Collecting sensitive information for security clearance can be complex and daunting. This security clearance form template is designed to help organizations like yours gather essential background details from applicants efficiently. With just a few clicks, you can ensure a straightforward process for your candidates, maintain compliance with regulations, and easily manage data gathering. You'll also improve response accuracy, save time on manual data entry, and facilitate secure information collection-all while utilizing a WCAG-aligned template that enhances user experience. Try out the live template to see how it fits your needs!

Use this Template (FREE) Live Preview
Full legal name
Date of birth
Place of birth (city, state/province, country)
Social Security Number (SSN) or national ID
Email address
Phone number
Gender
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Passport number(s) and issuing country/countries
Dual or multiple citizenship details (if applicable)
Current citizenship status
U.S. citizen
U.S. dual citizen
U.S. permanent resident
Non-U.S. citizen
Prefer not to say
Other
Please Specify:
Current residential address
Previous addresses for the past 5 years (include dates and landlords/roommates if known)
Mailing address (if different)
Current employer and position
Employment history for the past 10 years (include supervisors and dates)
Education details (schools, degrees, fields of study, dates)
Highest education level completed
High school or GED
Some college
Associate degree
Bachelor's degree
Master's degree
Doctorate
Trade/technical/vocational training
Other
Please Specify:
Military service details (branch, service number, dates, duty stations, discharge type)
Have you served in any military organization?
Yes
No
Do you have ongoing close and continuing contact with foreign nationals?
Yes
No
Foreign contact details (names, countries, relationship, frequency of contact)
Do you own, control, or have significant interest in foreign property, bank accounts, or businesses?
Yes
No
Foreign financial interest details (type, country, value, dates)
International travel details (countries visited, dates, purpose, sponsoring organization)
Have you traveled outside your country of citizenship in the past 7 years?
Yes
No
Have you ever been arrested, charged, or convicted of any offense?
Yes
No
Criminal history details (charges, dates, jurisdictions, outcomes)
In the past 7 years, have you used illegal drugs or misused prescription drugs?
Yes
No
Drug use details (substances, frequency, dates, circumstances)
Details of any current legal supervision or pending matters
Are you currently subject to probation, parole, restraining orders, or pending charges?
Yes
No
In the past 7 years, which of the following have occurred?
Bankruptcy
Debt sent to collections
Repossession or foreclosure
Tax lien
Court judgment for debt
Wage garnishment
Delinquent federal debt
None of the above
Approximate total amount of delinquent debt currently outstanding
$0
$1-$999
$1,000-$4,999
$5,000-$9,999
$10,000-$24,999
$25,000-$49,999
$50,000+
Prefer not to say
Tax issue details (years, amounts, status, repayment plans)
Have you failed to file or pay required taxes in any year?
Yes
No
Professional and personal references (2-3) with full names, relationship, phone, email, and address
Do you authorize us to contact these references?
Yes
No
Clearance level requested or required
Confidential
Secret
Top Secret
Top Secret/SCI
Not sure
Other
Please Specify:
Previous clearance details (level, issuing agency, dates, current status)
Employer or agency sponsoring this clearance (if known)
Have you previously held a government or agency security clearance?
Yes
No
I certify that the information provided is true, complete, and correct to the best of my knowledge
Yes
No
Typed full name as signature
Date of signature
I authorize the organization to conduct background investigations as permitted by law
Yes
No
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paper art illustration depicting a security clearance form with lines and fields for information and signatures

When to use this form

Use this template when you need to vet people for trusted roles or site access. HR, compliance, and project leads can screen staff, contractors, or vendors before granting badges, data access, or equipment. It is ideal for onboarding a developer to restricted systems, a contractor entering a secure facility, or a finance analyst handling sensitive funds. The form captures identity, address history, employment, travel, references, and consent for checks. You can pair it with a DBS Form for roles that work with vulnerable groups in the UK. The result: faster reviews, fewer emails, and a clear record you can share with approvers.

Must Ask Security Clearance Questions

  1. What is your full legal name, date of birth, and any previous names used?

    This confirms identity so you can match records and certificates without errors. It also reduces false positives when you screen across multiple databases.

  2. What are your addresses for the past 5-10 years, with dates for each?

    Address history shows where to run local checks and validates stability over time. Clear timelines help investigators verify claims quickly.

  3. Do you have any criminal convictions, cautions, or pending charges?

    This informs risk assessment and role suitability. If a police certificate is required, you can request it using the Online police clearance form.

  4. Provide your employment history for the past 5-10 years, explaining any gaps.

    Work history confirms experience and reveals unexplained breaks that may need review. It also gives you verifiable contacts for reference checks.

  5. Do you have any bankruptcies, defaults, or significant debts, including amounts, dates, and current status?

    Financial pressure can increase vulnerability to coercion. Specifics let reviewers weigh context and see evidence of repayment or arrangements.

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