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Human Resources [2]
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Lisa Green's Files
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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. envelope
Lisa Green; RE: address (1 page)
n.d.
P6/b(6)
002. form
Executive Branch Personnel Public Financial Disclosure Report; RE:
06/03/1999
P6/b(6)
personal info (6 pages)
003. form
Notification of Personnel Action; RE: personal info (2 pages)
04/19/1999
P6/b(6)
004. form
Fast Start Direct Deposit; RE: personal info (2 pages)
04/19/1999
P6/b(6)
COLLECTION:
Clinton Presidential Records
Policy Development
Lisa Green
OA/Box Number: 20586
FOLDER TITLE:
Human Resources [2]
2012-0043-S
ms221
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act 15 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA|
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
h(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
h(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
h(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. envelope
Lisa Green; RE: address (1 page)
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
Policy Development
Lisa Green
OA/Box Number: 20586
FOLDER TITLE:
Human Resources [2]
2012-0043-S
ms221
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office |(a)(2) of the PRA]
h(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRAJ
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA|
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
h(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
h(9) Release would disclose geological or geophysical information
2201(3).
concerning wells ((b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
002. form
Executive Branch Personnel Public Financial Disclosure Report; RE:
06/03/1999
P6/b(6)
personal info (6 pages)
COLLECTION:
Clinton Presidential Records
Policy Development
Lisa Green
OA/Box Number: 20586
FOLDER TITLE:
Human Resources [2]
2012-0043-S
ms221
RESTRICTION CODES
Presidential Records Act - (44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
financial information [(a)(4) of the PRAJ
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
h(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
THE WHITE HOUSE
WASHINGTON
MEMORANDUM FOR NEW EMPLOYEES
Lisa Green
FROM:
AMY COMSTOCK Allowstock
ASSOCIATE COUNSEL TO THE PRESIDENT
SUBJECT:
Financial Disclosure
As a federal government employee, you will be subject to criminal conflict of interest laws and
standards of conduct regulations. You should be provided with a copy of the regulations by the
Personnel Office as part of your in-briefing.
The basic conflict statute prohibits you from taking an official action that will have a direct and
predictable effect on your financial interests (or those of your spouse, minor child, or
organization with which you are affiliated as an officer, director, or partner). If you suspect that
you have a conflict of interest, please call me at 456-6229 before taking any official action.
To assist us in conducting a conflict analysis, certain employees are required to complete
financial disclosure reports. You have been identified as being required to file a public financial
disclosure report (SF 278) within 30 days of beginning your new position. Attached is an SF 278
and supplemental instructions for "new entrants." If you are transferring to the White House
from a position with another federal agency for which you were required to complete an SF 278.
please provide me with a copy of your most recent report. If you have questions as you are
preparing the report, please feel free to call me.
Attachments
* report due May 21, 99
HOW TO FILL OUT
THE EXECUTIVE BRANCH PERSONNEL
PUBLIC FINANCIAL DISCLOSURE REPORT (SF 278)
Supplemental Instructions for New Entrants
The SF 278 financial disclosure report will be reviewed and
certified by the Counsel's Office. Incomplete or incorrectly
filled out forms cannot be certified. You should, therefore,
complete the form carefully in accordance with the printed
instructions. The additional instructions below are intended to
help you avoid the most common problems.
If you have any questions about filling out this form,
please contact Amy Comstock at 456-6229.
GENERAL INSTRUCTIONS
Because filers often need more than one page for Schedules A
and D, you should make extra copies of those schedules before you
begin.
Please type or print your responses. Complete all sections
in Schedules A, C, and D. You should check the "NONE" box if you
have nothing to report. You should indicate "New entrant - not
applicable" in Parts I and II of Schedule B, which is for
incumbent and termination filers only.
Please do not leave any section blank. If you do not check
the "NONE" box (or write "New entrant - not applicable" on
Schedule B), someone will have to contact you for clarification.
Be sure to provide required information for your spouse and
dependent children.
1.
Cover Page
You must sign and date page 1. (An attorney, accountant or
other person may not sign for you.) Please provide a current
telephone number where you can be contacted for additional or
clarifying information.
2.
Schedule A - Assets and Income
a.
Reporting Period
The reporting period for Schedule A is the preceding
calendar year and the present year up to the closing date.
(Choose a closing date which is within the 30-day period prior to
the date you sign and file the form).
b.
Assets and Income Sources
Report all assets that are owned by you, your spouse or
dependent children for investment or income-producing purposes
which had a fair market value as of the closing date of more than
$1,000. ALSO report all sources of earned, investment and non-
investment income that yielded more than $200 in income during
the reporting period.
The reporting threshold for your spouse's earned income is
$1,000. The name and address of your spouse's employer and the
type of work performed should be identified. You need not report
the exact amount of a spouse's salary.
Some examples of reportable items:
stocks
bonds
real property
gold
art bought for investment purposes
debts owed to you, except by relatives
annuities
futures contracts
mutual funds
assets in your IRA
commercial animals
crops
a vested beneficial interest in a trust
fees
salaries
commissions
honoraria
partnership income
Interest-bearing checking and savings accounts and other
bank deposits or certificates of deposit must be reported if the
interest exceeds $200 in the reporting period OR if the total in
any one institution is over $5,000.
C.
What to show on form
(1) Give a description of the asset or source of income
and check the type of income and the category of amount of
income. For financial institutions, real property and
partnerships, include an address. Where a partnership is
reported, you should indicate if you are a limited or general
partner, and identify the nature of the business.
(2) DO NOT USE ABBREVIATIONS. Mutual funds, company
names and names of stocks should be spelled out completely.
2
(3) Rental property - Gross rental income (before any
deductions for depreciation/maintenance) should be reported.
Mortgages over $10,000 on rental property must be reported on
Schedule C. If the mortgage is below the reporting limit or if
there is no mortgage, please so indicate.
(4) Mutual Funds - the name of the investment firm as
well as the specific fund must be reported (e.g., Merrill Lynch
Basic Value Fund). If a fund is devoted to particular economic
or geographic sector, the sector should be indicated.
(5) IRAs - If an IRA contains other than cash, the
assets must be identified. Although interest/dividend income is
reinvested rather than distributed to you, it must nonetheless be
reported as income to you.
(6) Keoghs - In most cases, you will need to list and
value separately each of the assets held in the plan. You will
also need to indicate whether you determine the investments in
the Keogh or whether the plan is independently managed. If it is
independently managed, indicate if you can, the entity that
manages the plan. If a plan is both independently managed and
widely diversified (such that not more than 5 percent of its
holdings are issued by any one non-U.S.-government issuer and not
more than 20 percent of its holdings are in any one economic or
geographic sector), then you will not be required to list the
sub-assets of the plan but should instead state that the plan is
independently managed and widely diversified.
(7) Accounts with Stockbrokers - Each individual
security in the account must be reported separately.
(8) Private investment pools - Each portfolio holding
should be specifically identified and valued.
(9) Trusts - The individual holdings and income of any
trust in which there is a vested beneficial income or remainder
interest must be reported, unless the trust is an excepted trust
or specifically approved by the Office of Government Ethics as a
qualified trust.
(10) Assets that Have Been Sold - You are reporting the
value or the asset at the close of the reporting period. If you
no longer hold the asset, but you did receive more than $200 in
income from the asset during the reporting period, check the
"none (or less than $1,001) box in block B and indicate that the
item was sold. Also complete block C (see (12) below).
(11) "Other" Income - If you are reporting income that
is not from dividends, rent, interest, capital gains, or an
excepted or qualified trust, indicate the type of income in the
"Other" column, and give the exact amount of income in the column
3
labeled "Actual Amount Only if 'Other' Specified" (e.g.,
Partnership income - $9,382).
(12) More Than One Type of Income - Some items may
generate more than one type of income (e.g., rent and capital
gain income for a rental property sold during the reporting
period). Check two (or more) boxes for the category of income
and the total of the category of amount.
(13) Employee benefit plans - Each plan must be
specifically identified. For each plan, indicate if it is
independently managed or self-directed. If it is independently
managed, include if you can the name of the managing institution.
3.
Schedule B - Transactions and Gifts, Reimbursements and
Travel Expenses
New entrants are not required to complete Schedule B, you
should indicate "New entrant - not applicable" at the top of
Schedule B.
4.
Schedule C - Liabilities and Agreements and Arrangements
a. Part I - Liabilities
You must include the name and address of the creditor, the
type of liability, the date, term and interest rate, and the
highest value of the liability during the reporting period. When
reporting a mortgage (for rental or business property; not for
personal residences that are not rented out), you should indicate
for which property listed on Schedule A the mortgage is held.
b.
Part II - Agreements or Arrangements
(1) Describe all agreements or arrangements (not just
those entered into during the reporting period) concerning future
employment, leaves of absence, severance payments, continuing
payments from a former employer, or continuing participation in
employee pension, welfare or benefit plans (except those with the
United States Government).
(2) Note that any such payments must also be reported
on Schedule A.
(3) Specifically identify any present positions which
will be terminated upon entry into government service.
4
(5) Schedule D - Positions Held Outside U.S. Government and
Compensation in Excess of $5,000 Paid by One Source
The reporting for Schedule D is the preceding two calendar
years and the current year up to the closing date.
a. Part I - Positions Held Outside U.S. Government
Report and describe positions held by you in any for-profit
or non-profit organization at any time during the reporting
period. Be sure to include any partnership position you may
hold. Include both paid and unpaid positions and indicate
whether each one is paid or unpaid. If you received more than
$200 in compensation, you must report this income on Schedule A.
Positions with a religious, social, fraternal, or political
entity and positions of a solely honorary nature do not have to
be reported.
b.
Part II - Compensation in Excess of $5,000 Paid by One
Source
Report the source of income and nature of services performed
where you received more than $5000 in compensation. U.S.
Government income need not be reported. You must include in this
part a listing of clients of a firm if the firm received more
than $5,000 in compensation for services you provided.
5
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
LEGG CAPITAL
MASON MARKETS
THE WHITE HOUSE
WASHINGTON
PERSONAL DATA STATEMENT QUESTIONNAIRE
FROM:
OFFICE OF COUNSEL TO THE PRESIDENT
As part of the clearance procedures for your prospective position, please answer all of
the following questions (please do not respond "not applicable" or "N/A" if your
response is "no" or "none"). In responding to the questions, please supply any
information regarding your spouse or relatives that you deem to be relevant. Your
responses to this questionnaire, which is not subject to public disclosure, are
confidential.
You can type your responses in memorandum form on a separate sheet of paper with
each answer corresponding to the number of the question. You do not need to retype
the questions, but please sign and date the response.
Because your appointment cannot be finalized until all necessary reviews have been
completed, and because our review begins with receipt of your paperwork, please
supply this information within 14 days to Charles C. Easley, EOP Security Officer
(New Executive Office Building, Room 4026, Washington, D.C. 20503; fax
number: (202) 395-5608).
If you have any questions or need assistance in responding to this questionnaire,
please do not hesitate to contact the EOP Security Office at 202-395-6206. Thank
you for your cooperation.
Personal and Family Background
1.
Please list your full name; home address and telephone number; office address
and telephone number; date and place of birth; citizenship; and social security
number.
2.
Please identify your current marital status; spouse's name, citizenship,
occupation, and current employer; and the names and ages of your children.
3.
Do you have any medical conditions that could interfere with your ability to
fulfill your duties? Please explain.
Professional and Educational Background
4.
Please list each high school, college, and graduate school you attended; the
dates of your attendance; and degrees awarded.
5.
Please furnish a copy of your resume and a brief biographical statement.
6.
Please chronologically list activities, other than those listed on your resume,
from which you have derived earned income (e.g., self-employment, consulting
activities, writing, speaking, royalties, and honoraria) since age 21.
7.
Please list each book, article, column or publication you have authored,
individually or with others.
8.
Identify each instance in which you have testified before Congress in a non-
governmental capacity and specify the subject matter of each testimony.
2
9.
Please list all corporations, partnerships, trusts, or other business entities with
which you have ever been affiliated as an officer, director, trustee, partner, or holder
of a significant equity or financial interest G.e., any ownership interest of more than
5%), or whose decisions you had the ability to influence. Please identify the entity,
your relationship to the entity, and dates of service and/or affiliation.
10.
Please provide the names of all corporations, firms, partnerships, trusts, or
other business enterprises, and all non-profit organizations and other institutions with
which you are now, or during the past five years have been, affiliated as an advisor,
attorney or consultant. It is only necessary to provide the names of major clients and
any client matter in which you and your firm are involved that might present a
potential conflict of interest with your proposed assignment. Please include dates of
service.
11. With regard to each of the entities identified in the preceding question, please
identify your relationship or duty with regard to each. Please include dates of
service.
12. Other than the entities identified in question number 10 above, please provide the
names of any organizations with which you were associated which might present a
potential conflict of interest with your proposed assignment. For each entity you
identified in your response to this question please provide your relationship or duty
with regard to each. Please include dates of service.
3
13.
Please describe any contractual or informal arrangement you may have made
with any person or any business enterprise in regard to future employment or
termination payments or financial benefits that will be provided you if you enter
government employment.
14.
If you are a member of any licensed profession or occupation (such as lawyer,
doctor, accountant, insurance or real estate broker, etc.), please specify: the present
status of each license; and whether any such license has ever been withdrawn,
suspended, or revoked, and the reason therefor.
15. Do you have a significant interest in any relationship with the government
through contracts, consulting services, grants, loans or guarantees? If yes, please
provide details.
16.
Does your spouse or any family member or business in which you, your
spouse or any family members have a significant interest have any relationship with
the federal government through contracts, consulting services, grants, loans or
guarantees? If yes, please provide details.
17.
If you have performed any work for and/or received any payments from any
foreign government, business, or individual in the past 10 years, please describe the
circumstances, and identify the source, and dates of services and/or payments.
18.
Please list any registration as an agent for a foreign principal, or any
exemption from such registration. Please provide the status of any and all such
registrations and/or exemptions (i.e., whether active and whether personally
registered).
4
19.
Have you ever registered as a lobbyist or other legislative agent to influence
federal or state legislation or administrative acts? If yes, please supply details
including the status of each registration.
Tax and Financial Information
20.
As of the date of this questionnaire, please list all assets with a fair market
value in excess of $1,000 for you and your spouse and provide a good faith estimate
of value.
21. As of the date of this questionnaire, please list all liabilities in excess of $10,000
for you and your spouse. Please list the name and address of the creditor, the amount
owed to the nearest thousand dollar, a brief description of the nature of the obligation,
the interest rate (if any), the date on which due, and the present status (i.e., is the
obligation current or past due).
22.
Please describe all real estate held in your name or in your spouse's name
during the last six years. Please include real estate held in combination with others,
held in trust, held by a nominee, or held by or through any other third person or title-
holding entity. Please also include dates held.
23.
Have you and your spouse filed all federal, state and local income tax returns?
24.
Have you or your spouse ever filed a late income tax return without a valid
extension? If so, describe the circumstances and the resolution of the matter.
5
25.
Have you or your spouse ever paid any tax penalties? If so, describe the
circumstances and the resolution of the matter.
26.
Has a tax lien or other collection procedure ever been instituted against you or
your spouse by federal, state or local authorities? If so, describe the circumstances
and the resolution of the matter.
Domestic Help Issue
27. Do you presently have or have you in the past had domestic help? (i.e., a
housekeeper, babysitter, nanny, or gardener) If yes, please indicate years of service
for each individual and also give a brief description of the services rendered.
Public and Organizational Activities
28.
Please list current and past political party affiliations.
29.
Have you ever run for public office? If yes, does your campaign have any
outstanding campaign debt? If so, are you personally liable? Please also provide
complete information as to amount of debt and creditors.
30.
Please list each membership you have had with any civic, social, charitable,
educational, professional, fraternal, benevolent or religious organization, private club,
or other membership organization (including any tax-exempt organization) during the
past 10 years. Please include dates of membership and any positions you may have
had with the organization.
6
31.
Have you or your spouse at any time belonged to any membership
organization, including but not limited to those described in the preceding paragraph,
that as a matter of policy or practice denied or restricted affiliation (as a matter of
either policy or practice) based on race, sex, ethnic background, religious or sexual
preference?
Legal and Administrative Proceedings and Filings
32.
Please list any lawsuits you have brought as a plaintiff or which were brought
against you as a defendant or third party. Include in this response any contested
divorce proceedings or other domestic relations matters.
33.
Please list and describe any administrative agency proceeding in which you
have been involved as a party.
34.
Please list any bankruptcy proceeding in which you or your spouse have been
involved as a debtor.
35.
Have you or your spouse ever been investigated by any federal, state, military
or local law enforcement agency? If so, please identify each such instance and supply
details, including: date; place; law enforcement agency; and court.
36. Have you or your spouse ever been arrested for or charged with, or convicted of
violating any federal, state or local law, regulation or ordinance (excluding traffic
offenses for which the fine was less than $100)? If so, please identify each such
instance and supply details, including: date; place; law enforcement agency; and
court.
7
37. Have you or your spouse ever been accused of or found guilty of any violations
of government or agency procedure (specifically including security violations and/or
any application, or appeal process)?
38.
Please list any complaint ever made against you or by any administrative
agency, professional association or organization, or federal, state or local ethics
agency, committee, or official.
39. Please list any and all judgments rendered against you including the date,
amount, the name of the case and subject matter of the case, and the date of
satisfaction. Please include obligations of child support and alimony and provide the
status of each judgement and/or obligation.
40. With regard to each obligation of child support and/or alimony, please state the
following: Have any payments been made late or have there been any lapses in
payment? Have any motions or court actions for modification of child support or
alimony been filed or instituted? Have any actions or motions to compel payment or
initiate collection of late payments and/or past due amounts been filed or threatened?
Have any writs of garnishment been issued? If your response was yes to any of the
above questions, please provide details.
Miscellaneous
41.
Have you ever had any association with any person, group or business venture
that could be used, even unfairly, to impugn or attack your character and
qualifications for a government position?
8
42. Do you know anyone or any organization that might take any steps, overtly or
covertly, fairly or unfairly, to criticize your appointment, including any news
organization? If so, please identify and explain the basis for the potential criticism.
43.
Please provide any other information, including information about other
members of your family, that could suggest a conflict of interest or be a possible
source of embarrassment to you, your family or the President.
9
THE WHITE HOUSE
WASHINGTON
MEMORANDUM FOR PROSPECTIVE WHITE HOUSE STAFF
FROM:
EOP SECURITY OFFICE
RE:
DIRECTIONS FOR COMPLETING THE SECURITY PACKET
Before a final decision on your employment can be made, certain background investigations and
conflict-of-interest reviews must be completed. Accordingly, you are being provided with the
enclosed package of security clearance forms and questionnaires for your completion. The FBI cannot
begin its full-field investigation until your forms are TYPED, completed and signed.
A completed package should consist of:
ITEM
NUMBER OF COPIES NEEDED
1. Questionnaire for
One original and Two copies, all with
Sensitive Positions
original signatures. Note: The SF-86
(SF-86) plus any
requires two or three (Medical Release)
attachments.
signatures.
2. Tax Check Waiver
Total of four copies double-sided with
original signatures.
3. Personal Data Statement
One original copy.
4. Credit Check Consent Form
One original copy.
These forms must be TYPED and by federal law, must be submitted within 2 weeks of arriving on
duty at the White House, or we will be required to place you in leave without pay status. We ask that
you submit the forms as soon as possible, and within 14 DAYS of arriving on duty to the EOP
Security Office, NEOB 4026.
The SF-86 Form is available on computer in Room 4020, NEOB, 24 hours a day, seven days a week.
You are required to supply your own formatted 3 1/2 inch diskette.
If you have any questions or concerns, please contact the EOP Security Office at 202-395-6206.
Thank you.
INSTRUCTIONS FOR COMPLETING STANDARD FORM 86,
"QUESTIONNAIRE FOR NATIONAL SECURITY POSITION"
It is imperative that the following instructions be read and
followed when completing the Standard Form 86 (SF-86).
Although many of the questions on the SF-86 ask you to answer
looking back 7 years, you must answer looking back 15 years or to
your 18th birthday, whichever is more recent.
As a prospective Presidential appointee or an individual applying
for access to the White House complex, it will be necessary for
you to provide additional information to that requested on the
SF-86. It is essential that all information be provided in as
much detail as requested in order to ensure that the FBI is able
to conduct a thorough and complete investigation. Ambiguous and
incomplete information will impede the investigation and will
cause valuable time to be lost in the investigative process.
GENERAL INSTRUCTIONS
1. Although the instructions on the SF-86 indicate that you
may legibly print your answers, you must type this form and all
attachments.
2. Do not abbreviate the names of cities. Please include
zip codes, as well.
3. Be specific; exact and complete dates, names, addresses,
and explanations will be helpful for the expeditious handling of
the investigation. When you have completed the form, please
review it for thoroughness and continuity.
4. Make sure all copies have original signatures (not
traced over a copied signature) on all pages requiring
signatures. Signature are required on pages 9, 10 and 11.
SPECIFIC INSTRUCTIONS
Section #8
Citizenship: If you are a U.S. citizen other than
by birth.
Section #9
Where you have lived: If a residence is in an
apartment complex, include the name of the complex
and the specific unit number. If the residence
was leased or rented, include the name of the
individual in whose name the rental agreement or
lease was established.
Section #10
Where you went to school: Although it asks you to
*
list schools starting with the most recent and working
back 7 years, please list all education received
including high school.
Section #11
Your employment activities: Please provide complete
addresses (street/city/state/zip code) for each
employment and job description listed. If government
employment or employment by some other large organization
is to be listed, indicate the department, bureau, division,
and section, or specific subdivision.
Include all periods of unemployment, self employment,
volunteer employment, or internships. Please provide
names, complete addresses and telephone numbers of
persons who can verify periods of unemployment or
self-employment, to include individuals employed by
you, landlords, friends, cohabitant, competitors,
or clients.
Section #12
People who know you well: Please provide
complete business (including names of businesses)
and business telephone numbers. (Both home and work
addresses must be provided).
Section #14
Your relatives and associates: Although the SF-86
requests only the country of birth, also provide the
*
city and state or city and country of birth. If
any relatives or cotenant were born outside the United
States and/or are a U.S. citizen other than
by birth, execute the 'Immigration Addendum OFI 36."
If relatives live overseas, please indicate whether
or not they are with the military. Provide their
complete addresses, including city and country. Do not
list APO or FPO addresses.
Include the full name, complete date of birth, and
place of birth (city and state) of all individuals who
presently reside in your household, not only those who are
non-U.S. citizens.
Section #16
Your military history: If you are a member of a
military reserve component or National Guard unit,
list the organization, its location, the name of your
immediate officer and telephone number, if any.
Section #20
Your selective service record: If you have
registered with the Selective Services, you must
include your registration number. Inquiries into
your registration can be directed to the Selective
Service at 847-688-6888.
Section #21
Your employment record: If you have ever been denied
employment while undergoing or upon completion of a
background investigation or polygraph examination,
please identify prospective employer and date and
reason for voluntary/involuntary withdrawal from
consideration.
Section #23f
Your police record: Please indicate all arrests,
charges, and convictions except traffic fines of
$150.00 or less.
Sections #24 and 25
Use of illegal drugs and drug activity/use of
alcohol: Do not limit your responses to these questions
to the last 7 years, instead your answers must go back to
your eighteen birthday. List and explain if you have ever
abused any legal/prescription drugs to the point of
dependency. In addition, list any treatment for drug
and/or alcohol abuse.
Sections #27 and 28
Your financial record: If a collection procedure has ever
been instituted against you by federal, state, or local
authorities, please give full details. If you received
financial aid during college, indicate whether or not such
obligations have been satisfied.
If you have any questions, please call the EOP Security Office
at 202-395-6206.
FINANCIAL DISCLOSURE REQUIREMENTS
Public Financial Disclosure (SF-278)
Under Federal law, you must file a public financial disclosure
report are: (SF-278) within 30 days of beginning employment, if you
paid at a rate greater than $81,529; or
a Commissioned Officer, even if paid at a lower rate.
Confidential Financial Disclosure (SF-450)
If you are not required to file a public report, you must file a
of beginning employment if you are:
confidential financial disclosure report (SF-450) within 30 days
in a position that has been designated as one involving
potential conflicts of interest because you have procurement
responsibilities or your job likely affects the economic
interests of persons outside the Government; or
designated as a Special Government Employee (SGE) ; whether
compensated or not.
Ask your supervisor whether your position is or should be
designated for confidential filing.
Obtaining Forms and Filing
Financial disclosure forms are available from the White House
Counsel's Office (Room #136, x66229) If you are required to file
a public or confidential report, you should obtain the
appropriate form. Be sure you file with the Counsel's Office
within the statutory time limit of 30 days. There is a $200 fine
for late filing and we cannot complete your clearance without the
necessary financial disclosure reports.
MEMORANDUM FOR ALL PROSPECTIVE PASSHOLDERS
From:
EOP SECURITY OFFICER
RE:
SECURITY BRIEFING REMINDER (ATTENDANCE IS MANDATORY)
This memo serves as official notification that all passholders to
the White House complex (which includes the OEOB, NEOB, Winder,
and Jackson Place) are required to attend a White House Security
Briefing for New Employees within the first six months of arriving
on duty. White House policy requires attendance at a security
briefing before a permanent pass can be issued.
The 103rd Congress passed H.R. 4539 on June 22, 1994, which reads
in part:
Hereafter the employment of any individual within the
Executive Office of the President shall be placed on
leave-without-pay status if the individual has not, within
six months of commencing such employment or by October 31,
1994 (whichever occurs later), had his or her background
investigations, if completed, forwarded by the counsel to the
President of the United States Secret Service for issuance of
the appropriate access pass.
Your background investigation cannot be forwarded to the United
States Secret Service until receipt of your attendance of a
security briefing has been received by our office.
The security briefing is scheduled on the last Thursday of each
month at 10:15 a.m., in room #450, OEOB. Please plan to attend
*
the first scheduled briefing after your arrival date on duty. Due
to occasional last minute scheduling changes, it is recommended
that you call the Executive Office of the President, Office of
Security, at (202) 395-6206 for confirmation of each scheduled
briefing.
This will be your only reminder.
THE WHITE HOUSE
WASHINGTON
TO BE OPENED BY
ADDRESSEE ONLY
Lisa L. Green
Rm. 145 OEDB
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
003. form
Notification of Personnel Action; RE: personal info (2 pages)
04/19/1999
P6/b(6)
COLLECTION:
Clinton Presidential Records
Policy Development
Lisa Green
OA/Box Number: 20586
FOLDER TITLE:
Human Resources [2]
2012-0043-S
ms221
RESTRICTION CODES
Presidential Records Act - 144 U.S.C. 2204(a)]
Freedom of Information Act 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
h(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
h(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA
h(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA|
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
004. form
Fast Start Direct Deposit; RE: personal info (2 pages)
04/19/1999
P6/b(6)
COLLECTION:
Clinton Presidential Records
Policy Development
Lisa Green
OA/Box Number: 20586
FOLDER TITLE:
Human Resources [2]
2012-0043-S
ms221
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
PI National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRAJ
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
h(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information |(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
h(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
h(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.