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Standard Form 86
Revised July 2008
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736

Form approved:
OMB No. 3206 0005
NSN 7540-00 634-4036
86-111

QUESTIONNAIRE FOR
NATIONAL SECURITY POSITIONS

U.S. Office of Personnel
Management 5 CFR Parts 731, 732,
and 736

11 WHERE YOU HAVE LIVED (Continued)
#2 Month/Year To

11/2007

Month/Year
03/2009

Status

Own

Military housing

Rent

Other (Explain)

Street address
3922 Georgetown CT

Apt.#

APO/FPO address
City (Country)
Washington
Name of person who knows you at this address
John Senchak

Current address
3811 Fallsway Terrace

State
DC

ZIP Code
20007

State
VA

ZIP Code
22066

Apt.#

APO/FPO address (if currently applicable)
City (Country)
Great Falls
Telephone number
703-939-5018
#3 Month/Year To

03/2002

Alternate contact number
Month/Year
11/2007

Status

Relationship

Own
Rent

 

Military housing
Other (Explain)

Landlord
Business associate

Neighbor
Friend
Street address
625 Sun Valley Dr

Other (Explain)

Apt.#

APO/FPO address
City (Country)
Woodland Park
Name of person who knows you at this address
Jeff Perkins

Current address
735 Sun Valley Dr.

State
CO

ZIP Code
80863

State
CO

ZIP Code
80863

Apt.#

APO/FPO address (if currently applicable)
City (Country)
Woodland Park
Telephone number
719-687-8265
#4 Month/Year To

03/2001

Alternate contact number

Relationship

Neighbor

Landlord
Business associate

Friend
Month/Year
03/2002

Status

Own

Military housing

Rent

Other (Explain)

Street address
2341 Santa Elena Dr.

Other (Explain)

Apt.#

APO/FPO address
City (Country)
Buena Park

State
CA

Name of person who knows you at this address

Current address

ZIP Code
90620

Apt.#

APO/FPO address (if currently applicable)
City (Country)
Telephone number

State
Alternate contact number

Relationship

Neighbor

 

Friend

Landlord

 

Other (Explain)

Business associate

 
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Page 3

ZIP Code

53478155