ATF F 8620.62 Pre-Screening Qualifications Certification

U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives

Last Name:

First Name:

OMB No. 1140-xxxx (xx/xx/xxxx)

Pre-Screening Qualifications Certification
Middle Name:

Suffix:

Social Security Number:

The Department of Justice (DOJ) and the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) have specific policies that an individual must be
in compliance with before being allowed access to ATF information, information technology systems, and/or facilities. This form will be used to make
a preliminary eligibility determination for potential contractors, task force officers, and volunteers. All potential candidates (contractors, task force
officers, and volunteers) must respond to the below questions and sign and date this Certification form. Those who do not wish to provide the
information will not be considered.
INSTRUCTIONS: Once the candidate completes the form and signs in the Certification section, the candidate must return it to the designated ATF
Contracting Officer’s Technical Representative (COTR) or ATF Sponsor. Contractor candidates may be instructed by their employer/potential employer to complete and return the form to the company. In that case, the company may review the information and provide the form to the COTR/ATF
Sponsor. The COTR/ATF Sponsor will review the responses to the questions and make a determination whether to further the candidate in the ATF
personnel security process. If necessary, the COTR/ATF Sponsor may consult with the Personnel Security Branch (PSB) for guidance.
NOTE: Current ATF employees, seeking future contract employment with ATF, may choose to complete this Certification form and provide it to the
COTR/ATF Sponsor currently responsible for overseeing the contract(s) in which the employee has an interest in working under as a future contractor.
The COTR/ATF Sponsor will review the completed form and attempt to validate the responses to the questions outlined in Section III, Conduct
Qualifications. The COTR/ATF Sponsor will notify the current ATF employee of the results of the preliminary eligibility determination for ATF
contract employment.
Section I. Agency Specific Qualifications
1. Prior to accessing ATF information, facilities, and/or information technology systems, you may be required to undergo a background investigation.
The scope of the investigation will vary, depending upon the services to be provided. Are you willing to submit to this background investigation
process?
Yes
No
2. The background investigation may consist of a review of your past and present claims of education; a review of your past and present employment
records; a review of your financial and criminal history; a review of your past and present involvement/use of drugs and alcohol; and extensive
interviews with former and current colleagues, neighbors, friends, professors, etc. Are you willing to provide written authorization for release of
this personal information?
Yes
No
3. DOJ policy requires that you provide proof that for 3 out of the last 5 years you have resided in the United States, worked for the United States in a
foreign country in a Federal or U.S. military capacity for 3 out of the last 5 years, and/or been a dependent of a Federal or U.S. military employee in
a foreign country for 3 out of the last 5 years. Are you able to provide sufficient documentation to meet this residency requirement? Yes
No
4. If you are applying for a position that only requires access to ATF facilities (not information or information technology systems), you must be a
U.S. citizen or foreign national legally permitted to reside in the U.S. If you are a foreign national, your country of citizenship must be listed on the
allied nations list published by the Department of State. Current countries on the allied nations list can be found on the following website:
http://www.opm.gov/employ/html/citizen.asp. Are you in compliance with these citizenship requirements? Yes
No
5. If you are a male born after December 31, 1959, and are at least 18 years of age, civil service employment law (5 U.S.C. § 3328) requires that you
must be registered with the Selective Service System, unless you meet certain exemptions under Selective Service law. Are you in compliance with
the Selective Service registration requirements?
Yes
No
N/A
6. You will be required to complete and sign a “Drug Use Questionnaire.” This questionnaire addresses lifetime use of illegal drugs and narcotics
(including circumstances, dates, associates, types/quantities of substances, locations used, and any law enforcement actions including arrests,
convictions, and other court actions). It also addresses activities involving the sale of illegal drugs and abuse of prescription drugs. Are you willing
to complete and sign the Drug Use Questionnaire? Yes
No
7. You will be required to complete and sign a “Financial History Questionnaire.” You must be able to provide proof of resolution of delinquent just
debt(s) by presenting documentation showing timely submission of payment, participation in a payment plan, or other legal remedy. If you have
delinquent debt(s), can you provide proof of resolution? Yes
No
8. If you are applying for a position that requires access to or assistance in the development, operation, management, or maintenance of information
technology systems, DOJ requires that you be a U.S. citizen or obtain a waiver from DOJ authorizing access to the systems. Are you in compliance with this U.S. citizenship requirement? Yes
If no, are you willing to apply for this DOJ waiver? Yes
No
No

ATF Form 8620.62
Revised (
)

9. Individuals selected for this position, or their spouse or minor child, shall not have, directly or indirectly, any financial interest, including
compensated employment, stocks, or proprietary interest in the alcohol, tobacco, firearms or explosives industries. (This includes being listed as a
responsible person on a Federal Firearms License or an Explosives License or Permit.) If you have an interest in any of these industries, you may
be required to relinquish it. If required, would you be willing to relinquish any ownership of or interest in the alcohol, tobacco, firearms or
explosives industries? Yes
No
10. Individuals selected for this position must present two forms of acceptable personal identification prior to being granted unescorted access to ATF
information, information technology systems, and/or facilities. One identification document must be state or Federally-issued and contain a
photograph. Are you able to provide this required identification?
Yes
No

Section II. Compliance with Federal Firearms and Explosives Laws
ATF’s responsibilities to enforce the Federal firearms and explosives laws make it a unique Federal employer that must ensure that no individual
prohibited from having access to firearms, ammunition, and explosives be granted unescorted access to ATF information, information technology
systems, and/or facilities. To verify compliance with this policy, please respond to questions 11 through 13, below.
11. Federal law states that it is illegal for a person who has been convicted of a misdemeanor crime of domestic violence or who has a qualifying order
of protection against him/her to possess a firearm or ammunition. The law also prohibits these persons from shipping, transporting, or receiving
firearms and/or ammunition. Can you legally possess, transport, ship, and receive firearms and ammunition?
Yes
No
12. Federal law prohibits the possession of firearms, ammunition, and explosives by a person who has been convicted of a crime punishable by a term
of imprisonment exceeding one year; is a fugitive from justice; is an unlawful user of a controlled substance; has been adjudicated as a mental
defective or committed to a mental institution; is an illegal alien or non-immigrant alien (with exceptions); has been discharged from the military
under dishonorable conditions; or has renounced his/her U.S. citizenship. Can you legally possess a firearm, ammunition, and explosives?
Yes
No
13. Federal law prohibits the receipt of firearms and ammunition, and the receipt or possession of explosives by a person who is under indictment for a
crime punishable by a term of imprisonment exceeding one year. Can you legally receive firearms and ammunition?
Yes
No
Can you legally receive and possess explosives?
Yes
No
Section III. Conduct Qualifications
ATF prides itself on the caliber of its employees, contractors, volunteers, students, and task force officers. These individuals must display and maintain
the highest level of conduct. While responding to the below questions, the individual should consider the timeframe(s) addressed in each question to
be retroactive from the date that this Certification form is signed. (If you respond yes to any of the below questions, please provide dates, circumstances, and details in the Comments section.)
14. During the past 10 years, has there been any kind of finding against you by, for example (but not limited to), a legal authority, an educational
institution, or an employer, that reflected upon your truthfulness, including a finding of lack of candor during a misconduct investigation or an
administrative proceeding?
Yes
No
15. Are there any pending criminal charges against you?

Yes

No

16. Have you ever retired, resigned, or otherwise left an employment prior to the conclusion of a pending misconduct investigation or an administrative
proceeding; before a disciplinary action was formally proposed; and/or before a final decision was made relating to your conduct?
Yes
No
Comments:

Pre-Screening Qualifications Certification: My responses to the above questions are true and correct to the best of my knowledge and belief and are
made in good faith. I understand that intentionally withholding, misrepresenting, or falsifying information will have a negative effect on my employment or service opportunities with ATF.
Signature (sign in ink):

Date Signed (date in ink):

ATF Form 8620.62
Revised (
)

Privacy Act Statement
The following information is provided pursuant to Sections 3 and 7(b) of the Privacy Act of 1974 (5 U.S.C. § 552a(e)(3)):
1. Authority. Solicitation of this information is made pursuant to Executive Orders 10450 and 13467. Disclosure of this information by the
individual is voluntary.
2. Purpose. To determine the eligibility of the individual for employment or service opportunities with ATF based on its agency specific and conduct
qualifications.
3. Routine Uses. The information will be used by ATF to make a determination as set forth in the Purpose section of this Statement. This information
becomes a part of the permanent personnel security record of all candidates and is included in Internal Security Record System - Justice/ATF-006
(68 FR 3555-6) and is subject to all of the published routine uses of the system of records. Specifically, information may be disclosed by ATF to
third parties while making a determination as to the individual’s fitness for employment or service opportunities with ATF.
4. Effects of Not Supplying the Requested Information. Failure to supply complete information may require ATF to make a determination of the
individual’s eligibility for employment or service opportunities with ATF based on the information available.
5. Disclosure of Social Security Number. Disclosure of the individual’s social security number is voluntary. Under Executive Order 9397, ATF has
the authority to solicit an individual’s social security number. The number may be used to verify the individual’s identity.

Paperwork Reduction Act Notice
The information required on this form is in accordance with the Paperwork Reduction Act of 1995. The purpose of the information is to determine the
eligibility of the individual for employment or service opportunities with ATF. This information collection is voluntary pursuant to Executive Orders
10450 and 13467.
The estimated average burden associated with this collection is 7 minutes per respondent or recordkeeper, depending on individual circumstances.
Comments about the accuracy of this burden estimate and suggestions for reducing it should be directed to Reports Management Officer, Bureau of
Alcohol, Tobacco, Firearms and Explosives, Washington, DC 20226.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number.

ATF Form 8620.62
Revised (
)