BAE SYSTEMS PROPRIETARY

Pre DV Eligibility Assessment Ye

s
N
o
1 Are you aged 21 or over? X
2 Are you a British citizen? X
3 Do you have dual nationality? X
4 Is at least one of your parents British? X
5 Have you been living in the UK for the past ten years (including working for X
British Forces overseas)?
6 If yes, have you spent more than three months out of the country in that X
period?
7 If yes, please list the countries you visited below with approximate dates
(MM/YYYY):
[Enter country here] [Enter dates here]
[Enter country here] [Enter dates here]
[Enter country here] [Enter dates here]
[Enter country here] [Enter dates here]
[Enter country here] [Enter dates here]
[Enter country here] [Enter dates here]
8 Do you have any close foreign connections? X
(includes but not limited to partners, family members, close friends).
[Please enter details of nationalities and relationships]
9 Are you able to provide three UK based references to cover the last ten year X
period, which would be prepared to be interviewed?
(These are people that know you well socially, but not related to you).
1 Do you frequently drink over the recommended weekly allowance? X
0 (2-3 units per day for women, 3-4 for men)
1 Have you taken class A drugs in the last 6 months, or class B in the last 12? X
1
1 Do you have any other addictions? X
2 (Gambling, dangerous pursuits, sexual etc.)
1 Do you have any serious medical conditions? X
3 (Including, but not limited to diabetes, heart conditions, clinical depression, epilepsy, mental
health disorders)
1 Would you be prepared to undergo a medical examination and a drugs test? X
4
1 Are you party to a tax avoidance scheme? X
5
1 Are you prepared to answer questions on your social media and internet usage X
6 honestly?
1 Are you currently subject to a bankruptcy order, or individual voluntary X
7 arrangement (IVA)?
1 Do you have access to a computer to complete an online vetting eForm? X
8
1 Are you party to any activity which you would be unable to discuss with a X
9 vetting officer?
2 Do you have any beliefs (personal, religious or political) which could be X
0 considered as extreme?

I declare that the information that I have provided is correct, to the best of my
knowledge.

BAE SYSTEMS PROPRIETARY

 BAE SYSTEMS PROPRIETARY

Pre DV
Name:
Eligibility Assessment Date:05/10/2016
JOHN F DOHERTY
NB. BAE Systems will collect, use, protect and retain the information on this form in connection with all matters
relating to our personnel administration and policies in accordance with the Data Protection Act 1998

BAE SYSTEMS PROPRIETARY