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

CUI (when filled in)
FOR NLSC USE ONLY
CONTROL NUMBER

NATIONAL LANGUAGE SERVICE CORPS (NLSC) APPLICATION

OMB No. 0704-0449
OMB approval expires
XX/XX/XXXX

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 12 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, at [email protected]. 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; 50 U.S.C. 1913, National Language Service Corps; and DoD Directive 5124.02, Under Secretary of Defense
for Personnel and Readiness (USD(P&R)).
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.
ROUTINE USE(S): Disclosure of records are generally permitted under 5 U.S.C. 522a(b) of the Privacy Act of 1974, as amended. 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. Additional routine uses are listed in the
applicable System of Records Notice, DHRA 07, National Language Service Corps (NLSC) Records at: https://dpcld.defense.gov/Portals/49/Documents/Privacy/SORNs/
OSDJS/DHRA-07.pdf
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.

SECTION I - PERSONAL INFORMATION
1.a. TITLE (X one)
Ms.

Mr.

Mrs.

Dr.

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

NEEDS DD67

3. TELEPHONE NUMBERS
a. CELL/MOBILE

b. HOME

4. E-MAIL ADDRESS

c. WORK

SECTION II - GENERAL INFORMATION

5. HOW DID YOU LEARN ABOUT THE NLSC?

6. (X one)
PERMANENT RESIDENT
(GREEN CARD HOLDER)

U.S. CITIZEN

7. ARE YOU 18 YEARS OF AGE OR OLDER?

YES

TEMPORARY RESIDENT
(I-688 CARD)

TEMPORARY VISA
(STUDENT/OTHER)

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 (Not a contractor)?
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:
b. STATUS:

TS/SCI
ACTIVE

TS

SECRET

INACTIVE

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

NO

DD FORM 2932, 20210624 DRAFT
PREVIOUS EDITION IS OBSOLETE.

CONFIDENTIAL

OTHER (please specify)
DATE GRANTED (YYYYMMDD):
EXPIRATION DATE (YYYYMMDD):
14. ARE YOU WILLING TO UNDERGO A BACKGROUND CHECK
INVESTIGATION?
YES

CUI (when filled in)

NO
Controlled by: DLNSEO
CUI Category: PRVCY
LDC: FEDCON
POC: [email protected]

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CUI (when filled in)
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:
(YYYYMMDD)

g. DEGREE RECEIVED:

h. MAJOR(S):

SECTION IV - LANGUAGE INFORMATION
16. PLEASE LIST ALL YOUR LANGUAGES BELOW AND ANSWER:
a. HOW WOULD YOU RATE YOUR SKILLS IN ENGLISH? (X one)

NEEDS DD67
NATIVE

VERY GOOD

GOOD

FAIR

POOR

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

OUTSIDE THE U.S.

LANGUAGE

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 SCORE:

TEST DATE:
(YYYYMMDD)

NAME OF TEST:

TEST SCORE:

TEST DATE:
(YYYYMMDD)

DD FORM 2932, 20210624 DRAFT
PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

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CUI (when filled in)
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 FIRST
NON-ENGLISH
LANGUAGE

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)

WORKING/LIVING
ABROAD

COLLEGE

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

SOMETIMES

RARELY

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

PAID

UNPAID

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 ENGLISH?
(If so, please list them below)

NEEDS DD67
NAME OF TEST:

TEST SCORE:

TEST DATE:

(YYYYMMDD)

NAME OF TEST:

TEST SCORE:

TEST DATE:

(YYYYMMDD)

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 SECOND
NON-ENGLISH
LANGUAGE
IF DONE, PROCEED
TO QUESTION 17

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

PAID

UNPAID

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 ENGLISH?
(If so, please list them below)

NAME OF TEST:

TEST SCORE:

TEST DATE:
(YYYYMMDD)

NAME OF TEST:

TEST SCORE:

TEST DATE:
(YYYYMMDD)

DD FORM 2932, 20210624 DRAFT
PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

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CUI (when filled in)
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 THIRD
NON-ENGLISH
LANGUAGE
IF DONE, PROCEED
TO QUESTION 17

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)

WORKING/LIVING
ABROAD

COLLEGE

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

SOMETIMES

RARELY

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

PAID

UNPAID

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 ENGLISH?
(If so, please list them below)

NEEDS DD67
NAME OF TEST:

TEST SCORE:

TEST DATE:

(YYYYMMDD)

NAME OF TEST:

TEST SCORE:

TEST DATE:

(YYYYMMDD)

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 FOURTH
NON-ENGLISH
LANGUAGE
IF DONE, PROCEED
TO QUESTION 17

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

PAID

UNPAID

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 ENGLISH?
(If so, please list them below)

NAME OF TEST:

TEST SCORE:

TEST DATE:
(YYYYMMDD)

NAME OF TEST:

TEST SCORE:

TEST DATE:
(YYYYMMDD)

DD FORM 2932, 20210624 DRAFT
PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

Page 4 of 5

CUI (when filled in)
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 THIRD
NON-ENGLISH
LANGUAGE
IF DONE, PROCEED
TO QUESTION 17

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)

WORKING/LIVING
ABROAD

COLLEGE

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

SOMETIMES

RARELY

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

PAID

UNPAID

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 ENGLISH?
(If so, please list them below)

NEEDS DD67
NAME OF TEST:

TEST SCORE:

TEST DATE:

(YYYYMMDD)

NAME OF TEST:

TEST SCORE:

TEST DATE:

(YYYYMMDD)

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)

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. DATE (YYYYMMDD)

b. SIGNATURE

DD FORM 2932, 20210624 DRAFT
PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

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