SECURITY CLEARANCES AND APPROVALS (Sanitized)

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96B01172R000800010001-3
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 6
• Document Creation Date: December 12, 2016
• Document Release Date: September 21, 2001
• Sequence Number: 1
• Publication Date: September 14, 1977
• Content Type: MF

Approved For *a$e;2002/o1/09 : CIA-RDP96B0117 10800010001-3
MEMORANDUM FOR: Chief, Policy and Plans Group
THROUGH: Deputy'Director of Security (PTOS)
STATINTLFROM:
Chief, Physical Security Division
SUBJECT: Security Clearances and Approvals
(New Series STATINT
1. (U/AIUO) Reference is made to your request for
comments regarding the proposed subject regulation. A
review of the proposed regulation has been made and two
areas involved in the regulation are of particular interest
to this Division.
2. (U/AIUO).S.ubparagraph g(2), entitled "Industrial
Contractor Approval-Secret (ISA-S)," should be reevaluated.
The investigative coverage outlined for access to Agency
information at the Secret level is deemed to be inadequate.
As you are aware, extremely sensitive Agency information is
classified at the Secret level, particularly so since the
promulgation of Executive Order (EO) 11652. Prior to EO
11652, much of this information carried .a Top Secret'clas-
sification. Access to highly sensitive Agency sources and
methods and operations information at the Secret level based
solely on investigative criteria of National Agency Checks
is, in our estimation, insufficient and not in keeping with
the Director's responsibility for the protection of this
information. Investigative standards-and criteria for. access
to Secret level information was the subject-of a special
Security Committee Working Group some time ago and this
Working Group recommended to the Security Committee that
a minimum five-year background investigation, in addition
to-National Agency Checks, be required. We feel any less
standard to be inadequate in face of current considerations
for improved security in the industrial contracting area.
Approved For ease 2002/01/09 : CIA-RDP96B01172ROD080001Q001-3
 Approved For Se 10O2i01/09 : CIA-RDP96B01172 IWP$POO Q001-3
#cd1'7 {{'~ i P' r
3.' (U/AIUO) Subparagraph j(2), entitled "No Escort
Access,"' appears to be a weak presentation.- It is felt
that any individual having unescorted access to an Agency
facility be investigated to staff standards per paragraph
c., including the polygraph requirement. It is difficult
to differentiate the degree and nature of access regarding
No Escort Access personnel, inasmuch as they have uncon-
trolledaccess to the facility and have, as a minimum,
sight recognition of covert staff and contract personnel.
Distribution:
Orig - Adse
D
- U/ 1JD/PhyS
- chrono
OS/PhySD peh
(14 Sep
STATIN
Approved F +eIeaae?2002/01/09: CIA-RDP96B011t2R000800010001-3
 ^ REQUEST FOR INDUSTRIAL SECURITY APPROVAL
f^ NOTICE OF PERSONNEL ACTION
~^ CONFIDENTIAL
Separation ^ Transfer
Name change to
^ SECRET
Withdraw prior approval request
Other (specify)
^ TOP SECRET
DATE
DATE
NAME AND ADDRESS OF CONTRACTOR (If subsidiary, include name of Parent Company)
NAME OF SUBJECT (last, first, middle)
DATE OF BIRTH
PLACE OF BIRTH
2
HOME ADDRESS
US CITIZEN
SOCIAL SECURITY NO.
YES NO
3
SUBJECT'S JOB TITLE
WORK LOCATION (if different from contract address)
4
SUBJECT WILL BE AWARE OF CUSTOMER'S IDENTITY ^ YES ^ NO
5
SUBJECT WILL BE USED ON CUSTOMER'S CONTRACT NO. TASK ORDER NO.
DOES SUBJECT POSSESS A CURRENT SECURITY CLEARANCE GRANTED BY A U.S. AGENCY? YES ^ NO
IF YES COMPLETE THE FOLLOWING:
6
NAME OF AGENCY GRANTING CLEARANCE
LEVEL
DATE AND PLACE GRANTED
IF YOUR RECORDS INDICATE SUBJECT PREVIOUSLY HELD A SECURITY CLEARANCE BY A U.S. AGENCY INDICATE LEVEL
7
WHEN GRANTED BY WHOM AND WHERE HE WAS EMPLOYED AT THAT TIME.
DO YOUR RECORDS INDICATE SUBJECT HAS EVER BEEN DENIED A SECURITY CLEARANCE BY A U S. AGENCY OR HAD A SECURITY
CLEARANCE SUSPENDED OR REVOKED? ^ YES ^ NO IF YES EXPLAIN
8
DO YOUR RECORDS INDICATE SUBJECT HAS EVER BEEN ARRESTED, CHARGED, OR HELD BY ANY LAW ENFORCEMENT AUTHORITY?
^ YES ^ NO IF YES EXPLAIN
DO YOUR RECORDS INDICATE ANYTHING NOT COVERED ABOVE THAT MIGHT HAVE A BEARING ON THIS SUBJECT BEING GRANTED A
GOVERNMENT SECURITY CLEARANCE?
10
11. TYPED NAME OF CONTRACTOR REPRESENTATIVE
12. SIGNATURE OF CONTRACTOR REPRESENTATIVE
FOR USE BY CUSTOMERS ONLY
^ INDUSTRIAL SECURITY APPROVAL GRANTED ^ PERSONNEL ACTION RECORDED
CONFIDENTIAL
SECRET
TOP SECRET
NAME OF CUSTOMER'S Approved) For Release 2002/01/09
yq Q~ ~+ S~ `~ FjT~ 014]
IF1~r9V~ I~R~IU I-J DATE
SIl
r
Approved For Relea4IiF 20MW0 -14PM1172R000800010001-3
)RM
79 1841 USE PREVIOUS EDITIONS (9.38)
 REQUEST FOR INDUSTRIAL SECURITY APPROVAL
DATE
^ SECRET ^ TOP SECRET ^ TOP SECRET UPDATE
INSTRUCTIONS: Print or type all answers. All questions and statements must be completed. If the answer is "None," so state. Do not misstate
or omit material fact since the statements made herein are subject to verification. If more space is needed, use the Remarks section, item 26, and
attach additional sheets if necessary. The information entered hereon is for official use only and will be maintained in confidence.
The Privacy Act of 1974 (5 U.S.C. 552a) requires that federal agencies inform individ-
uals who are asked to provide their social security numbers whether the disclosure is
mandatory or voluntary, by what authority the number is solicited and the uses that will
be made of the social security number. Disclosure by you of your social security number
is voluntary. The authority for this solicitation is Executive Order 9397. Your social
security number is used to aid in the positive identification of the person requesting
security approvals. Failure to provide your social security number may delay processing.
1. LAST NAME - FIRST NAME - MIDDLE NAME -
2. SEX
3. SOCIAL SECURITY NUMBER
4. ALIAS(ES) AND FORMER NAME(S) AND PERIODS OF USE:
5. MONTH, DAY, YEAR OF BIRTH
6. PLACE OF BIRTH
7. CITIZENSHIP
a. RELATIVES
DATE AND PLACE OF BIRTH
PRESENT ADDRESS
CITIZENSHIP
A. SPOUSE (Full Maiden Name)
B. FATHER
C, MOTHER (Full Maiden Name)
9. RESIDENCES (List all from 18th birthday or during past 15 years, whicheveris shorter.)
A, FROM
B. TO
C. NUMBER AND STREET (List Apt. No.)
D. CITY
E. STATE
10. EMPLOYMENT (List all from 18th birthday or during past 15 years, whichever is shorter.)
A. FROM
B. TO
C. EMPLOYER
D. POSITION
E. ADDRESS
11? EDUCATION (Account for all civilian and military academies)
MONTH AND YEAR
GRADUATE
FROM
TO
NAME AND LOCATION OF SCHOOL
YES
NO
DEGREE
 12.
C
ITIZEENSHIP INFORMATION
.~
~
~ C p pa Sp (
I AM A CITIZEN OF TH~/~,.,,.,,. E~FNFQCYQ4T @t~L-J~7rI g~rP2rIv11j a 1 ~~11A17 .R0nnQ9ORI0001- CITIZENSHIP
N ED BIRTH IN A FOREIGN COUNTRY OF UNITED STATES PARENTS El DERIVATIVE CITIZENSHIP
IF NATURALIZED, CERTIFICATE NO.
DATE NATURALIZED
WHERE NATURALIZED (City, County, State, and Court)
IF ALIEN, REGISTRATION NO.
CITIZEN OF WHAT COUNTRY
DATE AND PLACE OF LAST ENTRY INTO U.S.
13. ORGANIZATIONAL MEMBERSHIP
LIST ALL ORGANIZATIONS EXCEPT LABOR UNIONS IN WHICH YOU HOLD OR HAVE HELD MEMBERSHIP.
NAME AND ADDRESS
TYPE
OFFICE HELD
FROM (Date)
TO (Date)
14. MILITARY SERVICE
A. COUNTRY
BRANCH OF SERVICE
RANK
SERVICE NUMBER
FROM (Date) I
TO (Date)
TYPE DISCHARGE
B. ARE YOU A MEMBER OF A RESERVE OR NATIONAL GUARD COMPONENT? ^ YES D NO (If answer is "YES", furnish service, component
and current status on additional page.)
15. LIST CHILDREN, BROTHERS, SISTERS (16 years and older)
RELATION
LAST, FIRST, MIDDLE NAME
ADDRESS
(Enter "deceaed) if no
longer living)
PLACE AND DATE
OF BIRTH
PRESENT
CITIZENSHIP
16. LIST NAMES OF ALL FORMER SPOUSES AND INDICATE DATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES,
OR ANNULMENTS;
17. INDICATE RELATIVES BY BLOOD, MARRIAGE, OR ADOPTION WHO EITHER (1) LIVE ABROAD, (2) ARE NOT U.S. CITIZENS.
(3) ARE NATURALIZED U.S. CITIZENS, OR (4) WORK FOR A FOREIGN GOVERNMENT
A .1. NAME (Last-First-Middle)
2. RELATIONSHIP
3. DATE OF BIRTH
11 4. P LACE OF BIRTH(City, State, Country)
5. CURRENT CITIZENSHIPS)
6.DATE U. S. CITIZENSHIP ACQUIRED
7. WHERE ACQUIRED (City, State, Country)
8. NATURALIZATION CERTIFICATE NUMBER
9. IF ALIEN, GIVE ALIEN REGISTRATION
N UVIBER
10. DATE AND PLACE OF ARRIVAL IN U.S.
11. CURRENT ADDRESS (Give last address, if deceased)
B. I. NAME (Last-First-Middle)
2. RELATIONSHIP
3. DATE OF BIRTH
4. PLACE OF BIRTH(City,State, Country)
5. FORMER CITIZENSHIP(S)
6. DATE U.S. CITIZENSHIP ACQUIRED
7. WHERE ACQUIRED (City, State, Country)
8. NATURALIZATION CERTIFICATE NUMBER
Approved For Rele
9. IF ALIEN, GIVE ALIEN REGISTRATION
sel? OU2/01/09 : CIA-RDP96B
10. DATE AND PLACE OF ARRIVAL IN U.S.
1172R000800010001-3
11. CURRENT ADDRESS (Give last address, if deceased),
 18. FOREIGN COUNTRIES VISITED OR RESIDED IN
CITY AND cApp 9ved For
eleas, 02/0
/09 : IA-RD
~~Q> ~?~Q~O~,~'~
96B01172N
F VISA
LEFT U.S.
RETURNED U.S.
19. LIST EACH FOREIGN GOVERNMENT, FIRM, CORPORATION OR PERSON FOR WHOM YOU ACTOR HAVE ACTED AS A REPRESENTATIVE,
OFFICIAL OR EMPLOYEE IN THE PAST 5 YEARS. LIST ALL COMMUNIST GOVERNMENTS, FIRMS OR CORPORATIONS.
20. REFERENCES (Give five personal references, two of whom know you on a current social basis. Do not include relatives, former employers, or
persons living outside the United States.)
NAME
YEARS
HOME ADDRESS
STATE.
CITY
STREET AND NUMBER
BUSINESS ADDRESS
STREET AND NUMBER, CITY, STATE,
KNOWN
,
,
TELEPHONE NUMBER
TELEPHONENUMBER
21. HAVE YOU EVER BEEN ARRESTED, CHARGED, OR HELD BY ANY LAW ENFORCEMENT AUTHORITIES FOR ANY VIOLATION OF ANY
LAW, REGULATION OR ORDINANCE? INCLUDE ALL COURTS-MARTIAL. DO NOT INCLUDE ANYTHING THAT HAPPENED BEFORE
YOUR 16TH BIRTHDAY. DO NOT INCLUDE TRAFFIC VIOLATIONS FOR WHICH THE ONLY PENALTY IMPOSED WAS A FINE OF $25.00
OR LESS. ALL OTHER CHARGES MUST BE INCLUDED EVEN IF THEY WERE DISMISSED.
DYES ^NO IF "YES", GIVE DATE AND PLACE, CHARGE, AND DISPOSITION
22. HAVE YOU EVER BEEN PREVIOUSLY PROCESSED FOR, GRANTED OR DENIED A CLEARANCE? (If answer is "YES", indicate level of
clearance granted, by whom and where employed at that time under Item 26, "Remarks".) 1 YES O NO
23. HAVE YOU EVER EXPERIENCED MENTAL OR NERVOUS DISORDERS WHICH REQUIRED PROFESSIONAL HELP? YES NO (If answer
to the above is "YES", explain. Give names and addresses of hospitals, clinics, sanitariums, and physicians, psychologists or psychiatrists who
have examined or treated you for such conditions.)
24. HAVE YOU EVER USED ILLEGAL DRUGS, INCLUDING MARIJUANA AND OTHER SOFT DRUGS, OR ABUSED PRESCRIPTION DRUGS?
0 YES E] NO (If answer is "YES", explain. State form(s) of drugs taken, how administered, dates and places, to what extent and under what
circumstances.)
25. ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF ANY FOREIGN OR DOMESTIC ORGANIZATION, ASSOCIATION, MOVEMENT,
GROUP, OR COMBINATION OF PERSONS WHICH IS TOTALITARIAN, FASCIST, COMMUNISTIC, OR SUBVERSIVE, OR WHICH HAS ADOPTED,
OR SHOWS, A POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OF FORCE OF VIOLENCE TO DENY OTHER PERSONS
THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES OR WHICH SEEKS TO ALTER THE FORMS OF GOVERNMENT OF THE
UNITED STATES BY UNCONSTITUTIONAL MEANS? YES NO (If the answer to the above question is "YES", list in item 26, the names
of all such organizations associations, movements, groupfi, or com ination of persons and dates of membership. Give complete details of your
activities therein and make any explanation you desire regarding your membership or activities.)
26. REMARKS (Use the space provided below and attach additional sheets, if necessary.)
above are true, complete, and correct
y me
I certify that the entries made b
SIGNATURE OF EMPLOYEE
~,{
;
to the best of my knowledAgnq?a~dda 16ga ai.geO2 U2h01/09 :
NN
CIA-RDP96BO1172R000800010001-3
FORM 1841A
7-78