Form PFPA Form 1408 PFPA Form 1408 Application Status Request

OMB No. xxxx-xxxx
OMB approval expires
XXXXX XX XXXX

DEPARTMENT OF DEFENSE
PENTAGON FORCE PROTECTION AGENCY
9000 DEFENSE PENTAGON
WASHINGTON, DC 20301-9000
APPLICANT STATUS REQUEST

The public reporting burden for this collection of information, xxxx-xxxx, is estimated to average 5 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 the burden
estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected].
Respondents should be aware that not withstanding 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 current valid OMB control number.

PRIVACY ACT NOTICE
Pentagon Force Protection Agency will not disclose information collected on this form to any source other than what has been authorized under the
Privacy Act of 1974 or 5 U.S. Code 552a for routine uses (i.e., information verifying an applicant’s employment status may be disclosed to a
prospective Agency that require information obtained in the completion of this form to help in the determination as to the individual’s fitness for federal
employment in the field of law enforcement) as identified in the system of records notice at OPM/GOVT-5 system of records at
http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article- View/Article/570737/opmgovt-5/. Your obligation to respond is voluntary,
but failure to provide requested information could impede processing.

Request information on the below listed who is applying for a position with the Pentagon Force Protection Agency. The applicant
informed us they applied with your agency for a law enforcement position. It would be beneficial to our investigation if you would
complete and return this questionnaire. An "Authorization for Release of Information" form is attached. If you have any questions
please contact the PFPA Recruitment Branch at (703) 571-8000.

1. Applicant
a. Name:

b. Date of Birth:

2.
a.
b.
c.

Applicant Information
When did the applicant apply to your agency?
What is the applicant’s current status?
Did the applicant make any drug statements?
If yes, what admission?
3. Please check which portions(s) of your selection process that the applicant completed with your
department and the results.
a.
Written Test
b.
Physical Performance Test
c.
Oral Board Interview
d.
Polygraph
e.
Background Investigation
f.
Psychological Investigation
4. Comments:

Satisfactory
Satisfactory
Satisfactory
Satisfactory
Satisfactory
Satisfactory

Unsatifactory
Unsatifactory
Unsatifactory
Unsatifactory
Unsatifactory
Unsatifactory

5. Employer Certification
a. Name:

b. Phone:

d. Signature:

e. Title:

PFPA FORM 1408, April 2018

c. Date:

FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE

Any misuse or unauthorized disclosure can result in both civil and criminal penalties.

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