Permanent Ineligibility - Persons formerly employed by the Central Intelligence Agency shall be permanently ineligible for employment by the Peace Corps. Ineligibility for a Minimum of Ten Years - Any person who had been employed by an agency or division of an agency, other than the Central Intelligence Agency, a substantial part of whose mission has been determined by the Peace Corps General Counsel to include intelligence activities, shall be ineligible for employment for a period of ten (10) years from the last date of employment by such agency. •
Form 1336: Peace Corps Intelligence Background Information
PEACE CORPS INTELLIGENCE BACKGROUND INFORMATION
The following information is required by Peace Corps Manual Section 611 entitled “Eligibility for Peace Corps Employment or Volunteer Service of applicants with Intelligence backgrounds.” If you have any questions, please contact the Peace Corps Office of General Counsel, 1990 K Street, N.W., Room 8349, Washington, D.C., 20526; telephone (202)606-3114. Eligibility for employment by the Peace Corps, MS 611, Part 4. •
Permanent Ineligibility - Persons formerly employed by the Central Intelligence Agency shall be permanently ineligible for employment by the Peace Corps. •
Ineligibility for a Minimum of Ten Years - Any person who had been employed by an agency or division of an agency, other than the Central Intelligence Agency, a substantial part of whose mission has been determined by the Peace Corps General Counsel to include intelligence activities, shall be ineligible for employment for a period of ten (10) years from the last date of employment by such agency. •
Ineligibility for a Period in Excess of Ten Years - Individuals may be ineligible for employment for a period in excess of ten (10) years where the General Counsel determines that their background or work history with regard to intelligence activities warrants such actions. •
Related Work - Applicants for employment whose background or work history discloses a substantial connection with an intelligence activity or related work other than through employment shall be ineligible to serve as employees of the Peace Corps for a period of time ordinarily not to exceed 10 years from the date of their last connection with the agency or activity. For the purpose of this provision, family relationship to an employee of an intelligence agency may be considered a disqualifying connection. Have you ever been employed by an intelligence organization or otherwise engaged in or been connected with intelligence related activities.
Yes
No
If yes, please explain below giving dates, nature of connection, and other details.
ATTENTION
have completed this statement with the knowledge and understanding that all items contained herein may be subject to investigation and verification prescribed by law or regulation. have read the paragraph relating to eligibility for a position as an employee, expert, consultant, or personal services contracts with the Peace Corps. l understand that a false answer or false information may be grounds for not employing me or for dismissing me after l have been hired, and may be punishable by fine or imprisonment. (US Code, Title 18, Section 1001).
CERTIFICATION
certify that all of the statements made by me are true, complete, and correct to the best of my knowledge and belief, and are made in good faith.
Signature (sign in ink)
Date
PC Form 13367/90
Stocked by: M/PM
Authority: MS 611
