973-537-6800

Parliament Security Questionnaire

QUESTIONNAIRE SUBMISSION

Please submit to:

Email:

Post: Global-Eyes Program, Global Internships, LLC
5 Meadow Lark Ct Randolph, NJ 07869

All information must be filled in to complete the security clearance process. Any answers not completed will only result in a delay to your security pass for Parliament being processed.

* Please note it can take up to 5 months to get passes for Parliament access. A pass is necessary to move feely and independently about the House.

Letter of Good Standing: Please provide a letter from your local police stating you are in good standing, have no prior convictions, and are not a security risk to a foreign country.
* Although this is required for all interns, a copy should accompany this security questionnaire.

Letter of Academic Standing: Please provide a letter from your school or employer stating that you are in good academic standing and have no behavior issues while at school or at work.

AGREEMENT

Please sign and date. If you are emailing the application, please scan your signature, or post the agreement page with signature separately.

I hereby confirm that all the information provided in this application is correct and current.
Print Full Name / Date
Signature

INTERN INFORMATION

Application Date:
Full Name: / Date of Birth / Male
Female
Home Telephone: / Marital Status:
City/State/Country of Birth: / Citizenship(s):
Current Address: / Lived at since:
(year)
Previous Address(s): / Years lived at
Years lived at
Years lived at
Years lived at
*Please list all addresses and dates for the past 6 years.
Have you ever had any criminal convictions? / YES NO
Have you ever been court martialed? / YES NO
Have you ever been involved with:
Espionage / YES NO
Terrorism / YES NO
Sabotage / YES NO
Overthrow of Government / YES NO
anyone who has committed any of the above / YES NO

FAMILY INFORMATION

Father / Status: / Living Deceased No contact with
Full Name: / Date of Birth:
Home Telephone: / Marital Status:
City/State/Country of Birth: / Citizenship(s):
Current Address: / Lived at since:
(year)
Mother / Status: / Living Deceased No contact with
Full Name: / Date of Birth:
Home Telephone: / Marital Status:
City/State/Country of Birth: / Citizenship(s):
Current Address: / Lived at since:
(year)
Mothers Maiden Name:
Spouse / Status: / Living Deceased No contact with
Full Name: / Date of Birth:
Home Telephone: / Marital Status:
City/State/Country of Birth: / Citizenship(s):
Current Address: / Lived at since:
(year)
If you or anyone in your family has dual citizenship please explain why:
If you no longer, or have never had contact with a parent please briefly explain:
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