SF-85 Workout Sheet

SF-85 Workout Sheet

1 Last Name / First Name / Middle Int.
2 DOB: / 3 Place of Birth: / 4 SSN:
5 Other name use:
6 Sex : Male Female / 7 Citizenship: US b. your mother Maiden name:
d. Dual Citizenship: / Country:

Where have you lived within the last 5 years?

From: / To: / Address: / Apt.# / City: / State / Zip Code
Name of Person Who Knew You / Address: / City / State / Zip Code
From: / To: / Address: / Apt.# / City: / State / Zip Code
Name of Person Who Knew You / Address: / City / State / Zip Code
From: / To: / Address: / Apt.# / City: / State / Zip Code
Name of Person Who Knew You / Address: / City / State / Zip Code
From: / To: / Address: / Apt.# / City: / State / Zip Code
Name of Person Who Knew You / Address: / City / State / Zip Code
From: / To: / Address: / Apt.# / City: / State / Zip Code
Name of Person Who Knew You / Address: / City / State / Zip Code

Where you went to school within the last 5 years?

1- High School 2- College/University/Military Collage 3- Vocational/Technical/Trade School

From: / To: / Code: / Name of School: / Degree/Completion/Other: / Month/year Awarded
Address of the School: / State / Zip Code
From: / To: / Code: / Name of School: / Degree/Completion/Other: / Month/year Awarded
Address of the School: / State / Zip Code
From: / To: / Code: / Name of School: / Degree/Completion/Other: / Month/year Awarded
Address of the School: / State / Zip Code
From: / To: / Code: / Name of School: / Degree/Completion/Other: / Month/year Awarded
Address of the School: / State / Zip Code

You’reEmployments Activities within the last 5 years?

1-Active Military 2- National Guard 3-USPHS Commission Corps 4-Other Federal Employment 5-State Government (Non-Fed employment) 6-Self –employment 7- Unemployment 8-Federal Contractor

From: / To: / Code: / Employer/Verifier Name/Military Duty Location: / Your Position Title/Rank:
Employer Verifier ‘s Street Address: / City / State / Zip Code
Supervisors Name / Street Address / City / State / Zip Code
From: / To: / Code: / Employer/Verifier Name/Military Duty Location: / Your Position Title/Rank:
Employer Verifier ‘s Street Address: / City / State / Zip Code
Supervisors Name / Street Address / City / State / Zip Code
From: / To: / Code: / Employer/Verifier Name/Military Duty Location: / Your Position Title/Rank:
Employer Verifier ‘s Street Address: / City / State / Zip Code
Supervisors Name / Street Address / City / State / Zip Code
From: / To: / Code: / Employer/Verifier Name/Military Duty Location: / Your Position Title/Rank:
Employer Verifier ‘s Street Address: / City / State / Zip Code
Supervisors Name / Street Address / City / State / Zip Code
From: / To: / Code: / Employer/Verifier Name/Military Duty Location: / Your Position Title/Rank:
Employer Verifier ‘s Street Address: / City / State / Zip Code
Supervisors Name / Street Address / City / State / Zip Code
From: / To: / Code: / Employer/Verifier Name/Military Duty Location: / Your Position Title/Rank:
Employer Verifier ‘s Street Address: / City / State / Zip Code
Supervisors Name / Street Address / City / State / Zip Code

People who know you well within the last 5 year?

Name: / From m/y / To m/y / Phone:
Home Address: / City: / State: / Zip Code
Name: / From m/y / To m/y / Phone:
Home Address: / City: / State: / Zip Code
Name: / From m/y / To m/y / Phone:
Home Address: / City: / State: / Zip Code