Form DD Form 2932 DD Form 2932 National Language Service Corp (NLSC) Application

NATIONAL LANGUAGE SERVICE CORPS (NLSC) APPLICATION

FOR NLSC USE ONLY
CONTROL NUMBER

OMB No. 0704-0449
OMB approval expires

PLEASE RETURN YOUR COMPLETED FORM TO:
NATIONAL LANGUAGE SERVICE CORPS, P.O. BOX 12221, ARLINGTON, VA 22219-2221

The public reporting burden for this collection of information is estimated to average 18 minutes per response, including the 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 this burden estimate or any other aspect of this collection
of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management
Division, 4800 Mark Center Drive, Alexandria, VA 22350-3100 (0704-0449). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any
penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. 131, Office of the Secretary of Defense; DoD Directive 5124.02, Under Secretary of Defense for Personnel and Readiness (USD(P&R));
50 U.S.C. 1913, National Language Service Corps.
PRINCIPAL PURPOSE(S): To allow U.S. citizens with language skills to self-identify their skills for the purpose of temporary employment on an intermittent work
schedule or service opportunities in support of DoD or another department or agency of the United States. The information will be used to determine applicants' eligibility
for NLSC membership and to identify and contact NLSC members. Submitted forms are covered by Privacy Act System of Records Notice DHRA 07, National Language
Service Corps (http://dpclo.defense.gov/Privacy/SORNsIndex/DODComponentArticleView/tabid/7489/Article/6689/dhra-07.aspx).
ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended, the records or information therein
may be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows:
To another department or agency of the United States in need of temporary short-term foreign language services, where government employees are required or desired.
The DoD Blanket Routine Uses found at http://dpclo.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx may apply to this collection.
DISCLOSURE: Voluntary; however, failure to provide information may result in non-enrollment in the NLSC and refusal to grant access to member areas of the NLSC
portal.

1.a. TITLE (X one)
MS.

MR.

MRS.

DR.

SECTION I - PERSONAL INFORMATION

b. LAST NAME

c. FIRST NAME

d. MIDDLE NAME

2.a. STREET ADDRESS

e. NICKNAME

b. APARTMENT/SUITE NUMBER

c. CITY

d. STATE

e. ZIP CODE

f. COUNTRY

3. TELEPHONE NUMBERS
a. CELL/MOBILE

b. HOME

4. E-MAIL ADDRESS

c. WORK

NEEDS DD 67
SECTION II - GENERAL INFORMATION

5. HOW DID YOU LEARN ABOUT THE NLSC?
6. (X one)
U.S. CITIZEN

PERMANENT RESIDENT
(GREEN CARD HOLDER)

TEMPORARY RESIDENT
(I-688 CARD)

TEMPORARY VISA
(STUDENT/OTHER)

7. ARE YOU 18 YEARS OF AGE OR OLDER?
YES
NO
8. IF YOU ARE A MALE, U.S. CITIZEN AND AT LEAST 18 YEARS OLD, HAVE YOU REGISTERED WITH THE SELECTIVE
SERVICE SYSTEM?
YES
NO
N/A
9. ARE YOU CURRENTLY OR HAVE YOU EVER BEEN A FEDERAL EMPLOYEE 1RWDFRQWUDFWRU?
CURRENT
FORMER
RETIREE
10. HAVE YOU EVER BEEN A POLITICAL APPOINTEE IN ANY CAPACITY FOR THE U.S. GOVERNMENT?
YES
NO
11. HAVE YOU EVER SERVED IN THE ARMED FORCES?

YES

NO

12. IF YOU HAVE EVER HELD A SECURITY CLEARANCE, PLEASE ANSWER THE FOLLOWING:
a. TYPE:

TS/SCI

b. STATUS:
ACTIVE
SPONSORING AGENCY:

SECRET

TS

INACTIVE

13. ARE YOU WILLING TO TAKE A DRUG TEST?
YES

NO

DD FORM 2932, 20140422 DRAFT

CONFIDENTIAL

OTHER (please specify)

DATE GRANTED:
EXPIRATION DATE:
14. ARE YOU WILLING TO UNDERGO A BACKGROUND CHECK
INVESTIGATION?
YES
NO
PREVIOUS EDITION IS OBSOLETE.

Page 1 of 5 Pages
Adobe Professional X

FOR NLSC USE ONLY
CONTROL NUMBER

NATIONAL LANGUAGE SERVICE CORPS (NLSC) APPLICATION
SECTION III - EDUCATION
15. PLEASE ENTER INFORMATION RELATED TO YOUR HIGHEST LEVEL OF EDUCATION:
a. NAME OF SCHOOL

b. CITY

c. STATE

e. DID YOU GRADUATE?

YES

NO

d. COUNTRY

f. DATE:
(MM/DD/YYYY)

g. DEGREE RECEIVED:

h. MAJOR(S):

NEEDS DD 67
SECTION IV - LANGUAGE INFORMATION

16. PLEASE LIST ALL YOUR LANGUAGES BELOW AND ANSWER:
a.

HOW WOULD YOU RATE YOUR SKILLS IN ENGLISH? (X one)
NATIVE

VERY GOOD

GOOD

FAIR

POOR

b. WHERE DID YOU LEARN ENGLISH? (X all that apply)
IN THE U.S.

ENGLISH
LANGUAGE

OUTSIDE THE U.S.

AT HOME AS A CHILD

SCHOOL (K-12)

HIGHER EDUCATION

AT HOME AS AN ADULT
(e.g., with family/spouse)

DEFENSE LANGUAGE
INSTITUTE OR OTHER U.S.
GOVERNMENT SCHOOL

COMMUNITY/
CHURCH/OTHER
FORMAL TRAINING

AT HOME

SCHOOL (K-12)

COLLEGE

WORKING/LIVING ABROAD

c. HOW OFTEN DO YOU USE ENGLISH? (X one)
ALWAYS

SOMETIMES

RARELY

d. HAVE YOU TAKEN ANY CERTIFICATION TESTS OR FORMAL TESTS IN ENGLISH?
(If so, please list them below)

NAME OF TEST:

TEST DATE:

TEST SCORE:
(MM/DD/YYYY)

NAME OF TEST:

TEST DATE:

TEST SCORE:
(MM/DD/YYYY)

DD FORM 2932, 20140422 DRAFT

Page 2 of 5 Pages

FOR NLSC USE ONLY
CONTROL NUMBER

NATIONAL LANGUAGE SERVICE CORPS (NLSC) APPLICATION
a.

HOW WOULD YOU RATE YOUR SKILLS IN THIS LANGUAGE? (X one)
NATIVE

VERY GOOD

GOOD

FAIR

POOR

b. WHERE DID YOU LEARN THIS LANGUAGE? (X all that apply)
IN THE U.S.

ENTER FIRST
NON-ENGLISH
LANGUAGE

OUTSIDE THE U.S.

AT HOME AS A CHILD

SCHOOL (K-12)

HIGHER EDUCATION

AT HOME AS AN ADULT
(e.g., with family/spouse)

DEFENSE LANGUAGE
INSTITUTE OR OTHER U.S.
GOVERNMENT SCHOOL

COMMUNITY/
CHURCH/OTHER
FORMAL TRAINING

AT HOME

SCHOOL (K-12)

COLLEGE

WORKING/LIVING ABROAD

c. HOW OFTEN DO YOU USE THIS LANGUAGE? (X one)
ALWAYS

SOMETIMES

RARELY

d. HAVE YOU EVER WORKED AS A...
TRANSLATOR

pai

unpai

nuer oears:

INTERPRETER

pai

unpai

nuer oears:

LANGUAGE TEACHER

pai

unpai

nuer o:

NEEDS DD 67

e. HAVE YOU TAKEN ANY CERTIFICATION TESTS OR FORMAL TESTS IN THIS LANGUAGE?
(If so, please list them below)

a.

NAME OF TEST:

TEST DATE:

NAME OF TEST:

TEST DATE:

(MM/DD/YYYY)
(MM/DD/YYYY)

TEST SCORE:
TEST SCORE:

HOW WOULD YOU RATE YOUR SKILLS IN THIS LANGUAGE? (X one)
NATIVE

VERY GOOD

GOOD

FAIR

POOR

b. WHERE DID YOU LEARN THIS LANGUAGE? (X all that apply)
ENTER SECOND
NON-ENGLISH
LANGUAGE
IF DONE, PROCEED
TO QUESTION 15

IN THE U.S.

OUTSIDE THE U.S.

AT HOME AS A CHILD

SCHOOL (K-12)

HIGHER EDUCATION

AT HOME AS AN ADULT
(e.g., with family/spouse)

DEFENSE LANGUAGE
INSTITUTE OR OTHER U.S.
GOVERNMENT SCHOOL

COMMUNITY/
CHURCH/OTHER
FORMAL TRAINING

AT HOME

SCHOOL (K-12)

COLLEGE

WORKING/LIVING ABROAD

c. HOW OFTEN DO YOU USE THIS LANGUAGE? (X one)
ALWAYS

SOMETIMES

RARELY

d. HAVE YOU EVER WORKED AS A...
TRANSLATOR

pai

unpai

nu o Years:

INTERPRETER

pai

unpai

nuer oears:

LANGUAGE TEACHER

pai

unpai

nu oears:

e. HAVE YOU TAKEN ANY CERTIFICATION TESTS OR FORMAL TESTS IN THIS LANGUAGE?
(If so, please list them below)

NAME OF TEST:

TEST DATE:

NAME OF TEST:

TEST DATE:

DD FORM 2932, 20140422 DRAFT

(MM/DD/YYYY)
(MM/DD/YYYY)

TEST SCORE:
TEST SCORE:
Page 3 of 5 Pages

FOR NLSC USE ONLY
CONTROL NUMBER

NATIONAL LANGUAGE SERVICE CORPS (NLSC) APPLICATION
a.

HOW WOULD YOU RATE YOUR SKILLS IN THIS LANGUAGE? (X one)
NATIVE

VERY GOOD

GOOD

FAIR

POOR

b. WHERE DID YOU LEARN THIS LANGUAGE? (X all that apply)
IN THE U.S.

ENTER THIRD
NON-ENGLISH
LANGUAGE
IF DONE, PROCEED
TO QUESTION 15

OUTSIDE THE U.S.

AT HOME AS A CHILD

SCHOOL (K-12)

HIGHER EDUCATION

AT HOME AS AN ADULT
(e.g., with family/spouse)

DEFENSE LANGUAGE
INSTITUTE OR OTHER U.S.
GOVERNMENT SCHOOL

COMMUNITY/
CHURCH/OTHER
FORMAL TRAINING

AT HOME

SCHOOL (K-12)

COLLEGE

WORKING/LIVING ABROAD

c. HOW OFTEN DO YOU USE THIS LANGUAGE? (X one)
ALWAYS

SOMETIMES

RARELY

d. HAVE YOU EVER WORKED AS A...
TRANSLATOR

pai

unpai

nuer oears:

INTERPRETER

pai

unpai

nuer oears:

LANGUAGE TEACHER

pai

unpai

nuer oears:

e. HAVE YOU TAKEN ANY CERTIFICATION TESTS OR FORMAL TESTS IN THIS LANGUAGE?
(If so, please list them below)

a.

NAME OF TEST:

TEST DATE:

NAME OF TEST:

TEST DATE:

(MM/DD/YYYY)

TEST SCORE:
TEST SCORE:

NEEDS DD 67
(MM/DD/YYYY)

HOW WOULD YOU RATE YOUR SKILLS IN THIS LANGUAGE? (X one)
NATIVE

VERY GOOD

GOOD

FAIR

POOR

b. WHERE DID YOU LEARN THIS LANGUAGE? (X all that apply)
ENTER FOURTH
NON-ENGLISH
LANGUAGE
IF DONE, PROCEED
TO QUESTION 15

IN THE U.S.

OUTSIDE THE U.S.

AT HOME AS A CHILD

SCHOOL (K-12)

HIGHER EDUCATION

AT HOME AS AN ADULT
(e.g., with family/spouse)

DEFENSE LANGUAGE
INSTITUTE OR OTHER U.S.
GOVERNMENT SCHOOL

COMMUNITY/
CHURCH/OTHER
FORMAL TRAINING

AT HOME

SCHOOL (K-12)

COLLEGE

WORKING/LIVING ABROAD

c. HOW OFTEN DO YOU USE THIS LANGUAGE? (X one)
ALWAYS

SOMETIMES

RARELY

d. HAVE YOU EVER WORKED AS A...
TRANSLATOR

pai

unpai

nuer oears:

INTERPRETER

PAID

UNPAID

NUMBER OF YEARS:

LANGUAGE TEACHER

PAID

UNPAID

NUMBER OF YEARS:

e. HAVE YOU TAKEN ANY CERTIFICATION TESTS OR FORMAL TESTS IN THIS LANGUAGE?
(If so, please list them below)

NAME OF TEST:

TEST DATE:

NAME OF TEST:

TEST DATE:

DD FORM 2932, 20140422 DRAFT

(MM/DD/YYYY)
(MM/DD/YYYY)

TEST SCORE:
TEST SCORE:

Page 4 of 5 Pages

FOR NLSC USE ONLY
CONTROL NUMBER

NATIONAL LANGUAGE SERVICE CORPS (NLSC) APPLICATION
a.

HOW WOULD YOU RATE YOUR SKILLS IN THIS LANGUAGE? (X one)
NATIVE

VERY GOOD

GOOD

FAIR

POOR

b. WHERE DID YOU LEARN THIS LANGUAGE? (X all that apply)
ENTER FIFTH
NON-ENGLISH
LANGUAGE

IN THE U.S.

AT HOME AS A CHILD

SCHOOL (K-12)

HIGHER EDUCATION

AT HOME AS AN ADULT
(e.g., with family/spouse)

DEFENSE LANGUAGE
INSTITUTE OR OTHER U.S.
GOVERNMENT SCHOOL

COMMUNITY/
CHURCH/OTHER
FORMAL TRAINING

IF DONE, PROCEED
TO QUESTION 15

OUTSIDE THE U.S.

AT HOME

SCHOOL (K-12)

COLLEGE

WORKING/LIVING ABROAD

c. HOW OFTEN DO YOU USE THIS LANGUAGE? (X one)
ALWAYS

SOMETIMES

RARELY

d. HAVE YOU EVER WORKED AS A...
TRANSLATOR

pai

unpai

NUMBER OF YEARS:

INTERPRETER

PAID

UNPAID

NUMBER OF YEARS:

LANGUAGE TEACHER

PAID

UNPAID

NUMBER OF YEARS:

e. HAVE YOU TAKEN ANY CERTIFICATION TESTS OR FORMAL TESTS IN THIS LANGUAGE?
(If so, please list them below)

NAME OF TEST:

TEST DATE:

NAME OF TEST:

TEST DATE:

(MM/DD/YYYY)
(MM/DD/YYYY)

TEST SCORE:
TEST SCORE:

17. OTHER QUALIFICATIONS (If you have other qualifications which you feel are beneficial or complementary to this application, please describe briefly here
or attach additional pages with your full name and date at the right of each additional page)

NEEDS DD 67

SECTION V - APPLICANT CERTIFICATION
I certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true, correct,
complete, and made in good faith. I understand that false or fraudulent information on or attached to this application may be
grounds for not hiring me or for dismissal from the organization after I begin work and may be punishable by fine or imprisonment.
I understand that any information I give may be investigated.
18.a. SIGNATURE
b. DATE (MM/DD/YYYY)

DD FORM 2932, 20140422 DRAFT

Page 5 of 5 Pages