Security Forms

Student Volunteer Internship Security Form

Welcome to the U.S. Attorney’s Office, Eastern District of New York! We look forward to your joining our team. If you have received and accepted an offer to participate in the Student Volunteer Internship Program (Law School and other Student Intern Programs) in our district, you will be required to complete a security clearance application, and have this clearance approve prior to your entrance on duty. Below is a checklist describing the items that we require you submit to process your security clearance. It can take 4-6 weeks to obtain your clearance once you submit your application.


All student intern security clearance applications are reviewed by our office and forwarded to Washington, DC. If you are offered a legal intern position, your participation will be contingent on a favorable evaluation of your background by the Department of Justice’s Office of Attorney Recruitment and Management, which reviews law student intern background materials.

Items on your application that may require additional documentation include: arrests, income tax issues, drug use, etc. The information requested must include a letter of explanation addressing each derogatory issue as well as supporting documents that a fine or violation was resolved, e.g., canceled payment checks and court document indicating that the matter is closed, etc.

All Applicants must submit the following documents for their clearance:

1) E-QIP Application- This is the online security application that needs to be completed. Please read the instructions attached here. Once completed, the two signature pages will need to be sent to our office.

Additional hardcopy forms needed for your security package:      

2) Color copy of valid US Passport- You only need the pages which provide the passport number, picture, expiration date and your signature. [Note: You may send us a color copy of your birth certificate in place of your passport]

3) Copy of your current Resume in Microsoft Word format- Your resume should mirror what was input on your e-QIP application.

4)SF-87A - Fingerprint Cards – Your security package must also include a set of fingerprint cards. If you want to have your fingerprints taken free of charge, contact Elizabeth Ferraro at (718) 254-6214 or Romel Hill at (718) 254-6191 to set up an appointment in the Brooklyn office.

-If coming to the office is not convenient, you can also have fingerprints done at a local police precinct for a fee. Please send us your address as soon as possible if you need cards mailed to you. The authorized official rendering the fingerprinting services must sign in the appropriate area as the administering official for each card. All boxes on the fingerprint cards accompanied by a red dot must be filled out. You must use black ink and send back to our office.

5) OARM Form 9A – Intern Ethical Obligations Agreement.

6) Student Volunteer Agreement Form – Complete these forms and include the name of your law school and the (printed) name of your school’s designated representative (career services office staff; registrar; bursar, or clinical professor, etc.) on the first page. Make sure all sections are filled out, including the top of the first page, which includes your name, the name of your school, and your school year level, 1, 2, or 3. For Section 1.7 and 1.8, respond with “May 22, 2014-September 5, 2014” on each line. Your School Registrar or Bursar representative must sign and stamp in the appropriate marked area. You must sign as well.

7) Certification for Non-Sensitive Positions – Please sign and date this form regarding security and return with your package. The dates you put on this form should be written “May 22, 2014-September 5, 2014.”

8) OF-306 –Declaration of Federal Employment – If you answer YES to any of the questions from 9 through 13, please contact the coordinators immediately to obtain information on additional documentation that may be required. Please sign and date on line 17A in this form.

9) OFI-36 - Complete this form only if you have immediate family members who are foreign born, a foreign born spouse, and/or a cohabitant (regardless of citizenship). Put your parents and siblings that are foreign born in Section A. Your spouse will go under Section B if foreign born and only individuals that live with you that are under duress with another country go under Section C.

Codes for Section A:

3- Stepmother
5- Foster Parent
6- Child (adopted also)
7- Stepchild
8- Brother
9- Sister

*If submitting OFI-36, you must also submit the Foreign Born Relatives or Associates Statement form.

10) Foreign Born Relatives or Associates Statement– You must include your immediate relatives (mother, father, spouse and siblings) who were born in a foreign country even if they currently hold U.S. citizenship.

11) Loyalty Statement – Complete this form only if you have dual citizenship or can be considered a citizen of another country. If this is the case, you must provide a “Letter of Explanation” concerning your dual citizenship status and sign the enclosed Loyalty Statement. The “Letter of Explanation” must give an explanation regarding the circumstances under which the dual citizenship was acquired and an offer to relinquish citizenship to the non-US country if so requested.

12) Parent Information – If your internship program will be more than 1 semester please provide complete names of your father and mother, including mother’s maiden name, date of births, place of births and their social security numbers.

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