SF-86A Continuation Sheet For Questionnaires SF 85, SF 85P and

CONTINUATION SHEET FOR QUESTIONNAIRES
SF 85, SF 85P, AND SF 86

Standard Form 86A
Revised April 2006
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736

Form approved:
OMB No. 3206 0005
NSN 7540-01-268-4828
86-111

For use with the SF 85, Questionnaire for Non-Sensitive Positions;
SF 85P, Questionnaire for Public Trust Positions;
and SF 86, Questionnaire for National Security Positions
INSTRUCTIONS: Use this form to continue your answers to “Where You Have Lived,” “Where You Went to School,” and/or “Your Employment Activities.” Follow the
instructions on the form for the particular questions you are answering and give information in the same sequence. Use as many continuation sheets as needed.
Your Social Security Number

Your Name

WHERE YOU HAVE LIVED (Continued)
Residence Information
Month/Year

To

Month/Year

#
Street address

Status
 Own
 Rent

Point of Contact for that Period of Residence
Name of person who knows you (last, first)
 Military Housing
 Other
Apt. #

Current address

APO/FPO address

#

(

APO/FPO address (if currently applicable)

City (Country)

Month/Year

Relationship
 Landlord
 Neighbor
 Business Associate
 Friend
 Other
Apt. #
Telephone number

State

To

Month/Year

Street address

Status
 Own
 Rent

Zip Code

City (Country)

State

Name of person who knows you (last, first)
 Military Housing
 Other
Apt. #

Current address

Zip Code

)

Alternate contact number
(

Relationship
 Neighbor
 Friend
Apt. #

)
 Landlord
 Business Associate
 Other
Telephone number
(

APO/FPO address
City (Country)

Month/Year

)

APO/FPO address (if currently applicable)
State

To

Month/Year

#

Status
 Own
 Rent

Street address

Zip Code

City (Country)

State

Zip Code

Alternate contact number
(

Name of person who knows you (last, first)
 Military Housing
 Other
Apt. #

Current address

Relationship
 Neighbor
 Friend
Apt. #

)
 Landlord
 Business Associate
 Other
Telephone number
(

APO/FPO address

)

APO/FPO address (if currently applicable)

City (Country)

State

Zip Code

City (Country)

State

Zip Code

Alternate contact number
(

)

WHERE YOU WENT TO SCHOOL (Continued)
#

Month/Year

To

Month/Year

Code

Degree/Diploma received?  YES  NO
(If “Yes,” explain, include mm/yyyy awarded.)

Name of school

Street address and City (Country) of school

State
Current address

Name of person who knew you (last, first)

#

Month/Year

To

Month/Year

Code

Apt. #

City (Country)

State

Telephone number

(
)
Degree/Diploma received?  YES  NO
(If “Yes,” explain, include mm/yyyy awarded.)

Name of school

Street address and City (Country) of school
Name of person who knew you (last, first)

ZIP Code

ZIP Code

State
Current address

Apt. #

City (Country)

State

ZIP Code

ZIP Code
Telephone number
(

Were you suspended or expelled from any of the institutions above?  YES
If “Yes,” explain. Do not include academic probations.

 NO

Enter your Social Security Number before going to the next page

)

CONTINUATION SHEET FOR QUESTIONNAIRES
SF 85, SF 85P, AND SF 86

Standard Form 86A
Revised April 2006
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736

Form approved:
OMB No. 3206 0005
NSN 7540-01-268-4828
86-111

EMPLOYMENT ACTIVITIES (Continued)
# Dates of Employment

Type of Employment

Month/Year

 Federal
 Military

To

Month/Year

 Military/Federal
 Unemployment
Contractor
 Self-employment
 State Government  Other

Employer/Verifier

Position title/Military rank
Work hours

Supervisor

Name of employer/verifier

Telephone number
(

 Full-time  Part-time

Name and title (last, first)

Telephone number

)

(

Address of employer/verifier

Address of supervisor

City (Country), State, and Zip Code

City (Country), State, and Zip Code

)

Physical Location
Your physical location (if different from employer address)

Telephone number
(

Additional Periods of Activity with this Employer
Month/Year

To

Month/Year

City (Country), State, and Zip Code

)

Position Title

Supervisor

Explanation/Reason for leaving

Reason for leaving code (if applicable)

# Dates of Employment

Type of Employment

Month/Year

 Federal
 Military

To

Month/Year

 Military/Federal
 Unemployment
Contractor
 Self-employment
 State Government  Other

Employer/Verifier

Position title/Military rank
Work hours

Supervisor

Name of employer/verifier

Telephone number
(

 Full-time  Part-time

Name and title (last, first)

Telephone number

)

(

Address of employer/verifier

Address of supervisor

City (Country), State, and Zip Code

City (Country), State, and Zip Code

)

Physical Location
Your physical location (if different from employer address)

Telephone number
(

City (Country), State, and Zip Code

)

Additional Periods of Activity with this Employer
Month/Year

To

Month/Year

Position Title

Supervisor

Explanation/Reason for leaving

Reason for leaving code (if applicable)

# Dates of Employment

Type of Employment

Month/Year

 Federal  Military/Federal
Contractor
 Military
 State Government

To

Month/Year

Employer/Verifier

Name of employer/verifier

 Unemployment
 Self-employment
 Other

Telephone number
(

Address of employer/verifier

)

Your physical location (if different from employer address)

Additional Periods of Activity with this Employer
Month/Year

 Full-time  Part-time

Name and title (last, first)

Telephone number
(

)

City (Country), State, and Zip Code

Physical Location

To

Work hours

Supervisor

Address of supervisor

City (Country), State, and Zip Code

Month/Year

Position title/Military rank

Position Title

Telephone number
(

City (Country), State, and Zip Code

)
Supervisor

Explanation

Reason for leaving code (if applicable)

PUBLIC BURDEN INFORMATION
Public burden reporting for this collection of information averages 20 minutes, including time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to OPM Forms Officer, U.S. Office of Personnel Management, 1900 E Street NW, Washington, DC 20415. Do not send your
completed form to this address, send it to the office that provided you the form. The OMB clearance number, 3206-0005, is currently valid. OPM may not collect this information,
and you are not required to respond, unless this number is displayed.

Enter your Social Security Number before going to the next page