You are here

Student Volunteer Internship Security Forms

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, 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 student intern background materials. You will be required to complete a security clearance application and have this clearance approved prior to your entrance on duty. Below is a checklist describing the items that we require you submit to process your security clearance.


Contact our office IMMEDIATELY if any of the following items apply to you as your security package will require additional documentation and may take longer to process: summonses (can include speeding tickets or other moving violations, open container violation), arrests, income tax issues, drug use, medical treatment from a doctor or psychiatrist, etc. With respect to summonses you will need documentation from the local jurisdiction that issued the summons to show that a fine was paid, community service completed or the matter dismissed. The information requested must include a letter of explanation addressing each derogatory issue.


1) Credit Report-DOJ-555 Form- Summer Law 2016 students have already received this and should have returned to Romel Hill If you have credit issues, including judgments, charge-offs, etc., you must contact us IMMEDIATELY – you must document that the debt is paid in full or that you are working with the creditor, have a payment plan and are making current payments.

2) E-QIP Application SF-85+P-S -This online security application must be completed immediately. You can access the E-QIP system at HTTP://WWW.OPM.GOV/INVESTIGATIONS/E-QIP-APPLICATION/ using the information you previously provided. Please read the instructions attached here.

3) Fingerprint Cards – Your security package must include a set of fingerprint cards. You will need to be printed for this internship regardless of the last time you were fingerprinted. If you want to have your fingerprints taken free of charge, contact Romel Hill at (718) 254-6191 to set up an appointment in the Brooklyn office.

-If coming to the Brooklyn 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.

4) JPEG Photo-A suitable photo of yourself should be emailed in JPEG form. It should be a clear headshot of you against a plain, white background.

4) Color copy of valid US Passport- Only photocopy the two 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]

5) Copy of your current Resume in Microsoft Word format only- Your resume should mirror what was input on your e-QIP application. Include any Legal and other experience within 7 years. All dates on your resume should follow the Month/Year format.

6) Student Volunteer Agreement Form

Page 1: You must bring the form to your Educational Institution Representative (Registrar or Bursar) and s/he must sign and date in the appropriate marked section. You, the student, will sign and date in your section. Please be sure to completely fill out the top of the first page- the Educational Institution is your full school name and your name goes on the Student Volunteer line. Leave the Designated Representative section blank.

Page 2: Fill out the top of page 2 and sign and date in your section. Leave the witness section blank.

Page 3: Your Educational Institution Representative must sign and date in the appropriate marked section.  You, the student, will sign and date in your section.

NYU (2 forms) New York University School of Law requires students to complete a Request Form as well as the Student Volunteer Agreement form. Our office will forward the forms to the registrar’s office and obtain the signatures. Please complete the Request Form and sign pages 1, 2, and 3 of the Student Volunteer Agreement form immediately and email Romel

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

8) OARM Form 9A

9) Federal Grand Jury Information- Non-Disclosure Agreement

10) Sensitive but Unclassified Information Non-Disclosure Agreement

11) IT Rules of Behavior forms.

12) Acknowledgement of Duty to Preserve Federal Records.


If any of the following statements apply to you, please include these essential forms:

I have answered “Yes’ to Section 12: Your Employment Record on the e-QIP application and have been terminated from a former employment within the past 7 years (1 form).

13) A letter of explanation is necessary if you have been fired from any job for any reason, quit after being told that you would be fired, left any job by mutual agreement because of specific problems, or were debarred from Federal employment by the Office of Personnel Management of any other Federal agency. If this applies to you, please type up a letter and provide the date, an explanation of the problem, reason for leaving, and the employer’s name and address, and upload the signed explanation.

I have answered ‘Yes’ to Section 20: Your Police Record on the e-QIP application and have been arrested for, charged with, or convicted of any offenses within the last 7 years (including fines or summonses or more than $150)

14) Please provide court documentation from the local jurisdiction that issued the summons and/or charges. The documentation must show that a fine was paid, community service completed or the matter dismissed. You must also include a letter of explanation addressing each derogatory issue.

I have answered ‘Yes’ to Sections 21: Illegal Drugs and 23: Your Use of Illegal Drugs and Drug Activity on the e-QIP application and have used illegal substances within the past 7 years (1 form)

15) Please provide a letter of explanation if you have answered’ yes’ to the above sections. The letter will address each time you have used an illegal substance and state if you are currently using controlled substances.

I have answered ‘Yes’ to Section 25: Medical Record on the e-QIP application, and pursued medical attention from a health care practitioner within the past 7 years (1 form).

16) If you have answered yes to Question 25: Medical Record on the SF-85 P+P-S and have consulted with a mental health care professional (psychiatrist, psychologist, counselor, etc.) or have consulted with another health care provider about a mental health related condition, your health care practitioner must provide a letter using their official letterhead and answer the following questions on the medical release form:

1) Confirm the dates that the professional has seen the applicant.

2) Does the person under investigation have a condition or medical treatment that could impair his/her judgment or reliability?

I was born outside the United States and/or I have dual citizenship with another country (2 forms).

17) 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 sign the enclosed Loyalty Statement and provide a separate, typed “Letter of Explanation” concerning your dual citizenship status. 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. If you were born outside of the United States but do not currently hold citizenship in another country, continue to fill out the loyalty statement; for the “Letter of Explanation”, please acknowledge that you were born outside of the United States in [country of birth] but do not have citizenship with such country.

My parent(s) were born outside of the United States (2 forms).

18) OFI-36 - List foreign-born parents in Section A. Codes: 1-Mother, 2- Father            

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

19) Foreign Born Relatives or Associates Statement– You must include your relatives listed on the OFI-36 form even if they currently hold U.S. citizenship.

I have lived outside of the United States within the past 5 years (1 form).

NOTICE: The U.S. Department of Justice requires that prospective law students meet a residency requirement which means that you must have lived in the United States for a total of 3 years (36 months) out of the last 5 years. The 5 years is counted going back from the month/date that you submit your online security application.

20) Study Abroad - If you have lived, worked, volunteered or studied abroad within the past 5 years, a typed explanation is essential for your security clearance. Please include the month/year that you were living outside of the country, what your purpose was and what month/year you returned to the United States. If it was a study abroad or internship program please include the name of the school program you participated in and if credit was received. If you were employed please include the name of your employer along with your title and clarify if this was a position with the federal government.  Each entry lived outside of the United States should be a separate paragraph. The letter must be typed and signed. An example is attached here.

Return to Eastern District of New York Internships

Return to the Eastern District of New York Home Page

Updated August 3, 2016