Application: General Interest Job at Cruz Associates, Inc. in Fort Campbell, KY; Indian Head, MD; Yorktown, VA

Fill out this section only if your employment with CAI requires a security clearance and you do not have one or if it is requested for vetting purposes: This employee information is voluntary, and the applicant agrees to provide the information to CAI for consideration, to determine if submittal of a security clearance request is appropriate or if vetting is required. The information is protected by Section 552a of title 5, United States Code “Privacy Act of 1974.” Cruz Associates’ logistics professionals provide hands-on organizational support as well as long-range sustainment planning to critical aviation commodities. Cruz Associates’ supports the Technology Applications Program Office and the 160th Special Operations Aviation Regiment across the entire spectrum of logistics functions. This questionnaire also encompasses Aviation / SOA(R) experience.

Q1. Fill out this section only if your employment with CAI requires a security clearance and you do not have one or if it is requested for vetting purposes: This employee information is voluntary, and the applicant agrees to provide the information to CAI for consideration, to determine if submittal of a security clearance request is appropriate or if vetting is required. The information is protected by Section 552a of title 5, United States Code “Privacy Act of 1974.”

Agree
Disagree

Q2. Date of Birth (MM/DD/YYYY):

Q3. Place of Birth (City, State, Country):

Q4. For your past employment record, have you been fired in the last seven (7) years?

Yes
No

Q5. For your past employment record, have you quit or left by mutual agreement after being told you would be fired in the last seven (7) years?

Yes
No

Q6. For your past employment record, have you received a written warning, been officially reprimanded, suspended, or disciplined for misconduct in the workplace, such as, but not limited, to a violation of security policy in the last seven (7) years?

Yes
No

Q7. Please provide three professional references from each of your most recent jobs. Please include the following: 1. Name 2. Phone Number 3. Company where you worked with them.

Q8. Have you served in the U.S. Military?

Yes
No

Q9. Did you retire from the U.S. military?

Yes
No

Q10. If the answer to #8 or #9 was yes, provide the type of discharge you received:

Q11. Were you born a male after December 31, 1959 and if so, have you registered with the Selective Service System (SSS)?

Yes
No
I do not know

Q12. If you answered yes to the prior question, please provide registration number if applicable. (Note: The Selective Service website, www.sss.gov, can help provide the registration number for persons who have registered. Note: Selective Service Number is not your Social Security Number)

Q13. In the past seven (7) years have you been charged, convicted, or sentenced of a crime in any Court? (Do not select yes if the offenses were expunged from your record)

Yes
No

Q14. Have you EVER been convicted in any court of the United States of a crime, sentenced to imprisonment for a term exceeding 1 year for that crime, and incarcerated as a result of that sentence?

Yes
No

Q15. Have you EVER been charged with any felony offense? (Include those under the Uniform Code of Military Justice and non-military/civilian felony offenses.)

Yes
No

Q16. In the past seven (7) years have you been or are you currently on probation or parole?

Yes
No

Q17. Have you EVER been convicted of an offense involving domestic violence or a crime of violence (such as battery or assault) against your child, dependent, cohabitant, spouse, former spouse, or someone with whom you share a child in common?

Yes
No

Q18. Do you have any civil or criminal actions pending in the court system?

Yes
No

Q19. In the last seven (7) years have you illegally used any drugs or controlled substances? (Use of a drug or controlled substance includes injecting, snorting, inhaling, swallowing, experimenting with or otherwise consuming any illegal drug or controlled substance)

Yes
No

Q20. Have you EVER been charged with an offense involving firearms or explosives? (Do not check yes if the offenses were expunged from your record)

Yes
No

Q21. Have you EVER been ordered, advised, or asked to seek counseling or treatment as a result of your use of alcohol or drugs?

Yes
No

Q22. In the last seven (7) years have you consulted with a health care professional regarding an emotional or mental health condition or were you hospitalized for another such condition?
Answer ‘No’ if the counseling was for any of the following reasons and was not court-ordered:
1. Strictly marital, family, grief not related to violence by you; or
2. Strictly related to adjustments from service in a military combat environment.

Yes
No

Q23. Has a court or administrative agency EVER declared you mentally incompetent?

Yes
No

Q24. Has the U.S. Government (or a foreign government) EVER investigated your background and found you eligible for a security clearance?

Yes
No

Q25. Have you ever been denied a Security Clearance?

Yes
No

Q26. In the past seven (7) years have you failed to file or pay Federal, state, or other taxes when required by law or ordinance?

Yes
No

Q27. In the past seven (7) years have you been delinquent on alimony or child support payments?

Yes
No

Q28. In the past seven (7) years have you had your wages, benefits, or assets garnished or attached for any reason?

Yes
No

Q29. In the past seven (7) years have you been over 120 days delinquent on any financial obligations? (Including financial obligations for which you were the sole debtor, as well as those for which you were a cosigner or guarantor)

Yes
No

Q30. In the past seven (7) years have you had bills or debts turned over to a collection agency? (Include financial obligations for which you were the sole debtor, as well as those for which you were a cosigner or guarantor)

Yes
No

Q31. Do you have, or have you had, close and/or continuing contact with a foreign national within the last seven (7) years with whom you, or your spouse, or cohabitant are bound by affection, influence, common interests, and/or obligation? Including associates as well as relatives.

Yes
No

Q32. Have you EVER served, as a civilian or military member in a foreign country’s military, intelligence, diplomatic, security forces, militia, other defense force, or government agency?

Yes
No

Q33. Have you EVER been a member of an organization that advocates or practices commission of acts of force or violence to discourage others from exercising their rights under the U.S. Constitution or any state of the United States with the specific intent to further such action?

Yes
No

Q34. Have you EVER knowingly engaged in activities designed to overthrow the U.S. Government by force?

Yes
No

Q35. If you answered “YES” to any of the above, please explain in this section. If not, please type N/A.

Q36. Please type your name to hereby certify that, to the best of my knowledge and belief, all of the information on and attached to this document is true, correct, complete, and made in good faith. Any falsification of the information provided within can be used as grounds for dismissal.

Q37. Please identify your Aviation Experience: