Personnel Security Pre-screen Questionnaire

Private Data
Vibrint Candidate: Thank you for taking the time to complete the security pre-screen questionnaire prior to your interview. The completed form will be encrypted in transit via https. Only members of Vibrint's security team will have access to your personal information.

If you have questions regarding this form, feel free to call Vibrint at 443-749-5785.
Please enable JavaScript in your browser to complete this form.

Personal Information

City, State & Country
If born overseas, please provide details
Mailing Address

Citizenship Information

1. Are you a United States Citizen?
2. Are all members of your immediate family (including spouse, children, parents, parents-in-law, cohabitants, half and step relations, or any person to whom you have close ties of affection or obligation) United States citizens?
3. Are any of the individuals mentioned above dual citizens of the United States and another country?

Foreign Contacts/Foreign Activities

4. Do you have any close and/or continuing contact with citizens of another country?
5. Do you have any foreign property, business connections, or foreign financial interests or assets?

Employment Record

6. Have you ever had any incidents involving misconduct or negligence reported by an employer that resulted in you receiving a written or verbal warning, security incident, resignation by mutual consent or termination?
7. Have you been fired from a job?
8. Have you left a job by mutual agreement following allegations of misconduct?
9. Have you left a job by mutual agreement following allegations of unsatisfactory performance?
10. Have you left a job for other under unfavorable circumstances?


11. Have you ever held a U.S. Government security clearance?
12. Do you currently have or have you ever had a Sensitive Compartmented Information (SCI) access?
13. Have you ever taken a polygraph as part of security clearance processing?
14. Do you have an active green community badge?
15. Have you ever had a security clearance or access denied, suspended, placed on inactive or revoked?
16. In the past twelve months have you had a security clearance crossover denied or delayed?

Illegal use of drugs and use of alcohol

17. Have you EVER used or sold any illegal narcotics?
18. Has your use of alcohol had a negative impact on your work performance or resulted in intervention by law enforcement/public safety personnel?

Financial Record

19. Have you filed a petition under any chapter of the bankruptcy code (to include Chapter 13)?
20. Do you currently have any debts that are greater than 90 days past due?
21. The agency may require a credit check upon security processing. Are you willing to consent to a credit check if required?

IT Authorization

22. Have you ever illegally or without proper authorization entered into any Information Technology (IT) system?
23. Have you ever illegally or without authorization modified, destroyed, or manipulated access to information residing on an IT system?
24. Have you ever introduced, removed, or used hardware, software, or media in connection with any IT systems without authorization, when specifically prohibited by rules, procedures, guidelines, or regulations?


25. Do you have any reason to believe your processing for an NSA clearance would not be successful?

By submitting this form, you are certifying the information provided is made in good faith and is true, complete and correct to the best of your knowledge and belief. You understand any false statement, misrepresentation, or omission of material fact may result in the withdrawal of sponsorship for clearance/access or termination of employment.