10/4/200395666847-99AD-4830-8BF9-E7165D5493021.8.7AFROTC FORM 35, 20060701, V1Times New Roman10plainoffapplication/vnd.xfdlapplication/vnd.xfdl;content-encoding="base64-gzip"UNONEAFROTC3520060701Certification of Involvements with Civil, Military, or School Authorities/Law Enforcement Officials13620Military PersonnelEFEFAFROTCI36-2011AFROTC/RRFP 493-7843PEAFPUBSFFADpermitIBM Lotus Forms Designer1020;1320B1D3190C-84B2-46F5-BCFA-947A3F8CCF62239,239,239255,255,255NAME826933736025offAY F O AY T S FORM 35, 2000, 11 08.
PREVIOUS EDITION IS OBSOLETE.
FOR OFFICIAL USE ONLY When filled in.
CERTIFICATION OF INVOLVEMENTS WITH CIVIL, MILITARY OR SCHOOL AUTHORITIES or LAW ENFORCEMENT OFFICIALS.
PRIVACY ACT STATEMENT.
1. AUTHORITY. 10 U S C 2101. 2. PRINCIPAL PURPOSES.
To provide information and data necessary for administering the Senior AY F R O T C.
program, and for the processing and managing of selected students for commissioned service in the U S AY F. s s ay n insures positive identification of the.
individual.
3. ROUTINE USES.
Information may be disclosed for any of the blanket routine uses published by the Air Force.
4. DISCLOSURE.
Voluntary. However, if information is not provided, the applicant cannot be evaluated for acceptance into the AFROTC.
I. STATEMENT TO THE APPLICANT or CADET.
A. The Detachment Commander must know if you have ever been arrested, convicted, involved with law enforcement officials or authorities for him or her to determine if you meet the character requirements for membership in Air Force R O T C. It is necessary for you to report any involvement with civil, military,.
or school authorities or law enforcement officials.
regardless of its insignificance, disposition, or finding on the certification provided below. Include traffic violations and any incidents which resulted in your being judged a juvenile offender. A finding of not guilty or advice by an attorney, court official, or anyone else to consider your record as clear does not constitute authority to leave the involvement off of the certification.
B. In the future, if you are arrested, detained, convicted, etc., you must report the incident to the Detachment Commander or his or her designated representatives within 72 hours following its occurrence. If such incidents occur during a period of leave from the institution e.g., student teaching or foreign study attendance at Field Training, or during normal vacation periods, the 72 hour time limit will apply effective with the official date of your return to the institution.
C. Concealing or failing to report an involvement with civil, military, or school authorities or law enforcement officials, giving false information or claiming subsequent to initial certification that you were unaware of the contents of this document may result in elimination from consideration for membership in the Air Force R O T C program, or, if already a member, may result in your discontinuance from the Air Force R O T C program. The information reported on this certification form will be treated as confidential matter, subject to the provisions of the Privacy Act of 1974 and the Freedom of Information Act.
CERTIFICATE. I, name, CERTIFY THAT THE INFORMATION CONTAINED IN THE FOLLOWING CERTIFICATIONS INCLUDES ALL ARRESTS, DETENTIONS, CONVICTIONS, INVOLVEMENTS, etcetera, THAT I HAVE HAD WITH CIVIL, MILITARY INCLUDING ART. 15 S. , OR SCHOOL AUTHORITIES or LAW ENFORCEMENT OFFICIALS REGARDLESS OF DISPOSITION OR SEEMING INSIGNIFICANCE. THE LISTS ARE COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. Enter nameDaniel J. LindstromTimes New Roman10plainwordwrapfixedglobalTYPINVL127349711925offRow 1, enter DATE OF INVOLVEMENT.TFLD_3_HELPdateoffwordwrapfixedcenterTYPINVL1ARREST1Enter YYYYMMDD (e.g., 19980805). This format is Y2K compliant.27353611925offRow 2, enter DATE OF INVOLVEMENT.TFLD_3_HELPdateoffwordwrapfixedcenterTYPINVL1_2ARREST1_227357511925offRow 3, enter DATE OF INVOLVEMENT.TFLD_3_HELPdateoffwordwrapfixedcenterTYPINVL1_3ARREST1_327361411925offRow 4, enter DATE OF INVOLVEMENT.TFLD_3_HELPdateoffwordwrapfixedcenterTYPINVL1_4ARREST1_427365311925offRow 5, enter DATE OF INVOLVEMENT.TFLD_3_HELPdateoffwordwrapfixedcenterTYPINVL1_5ARREST1_527369211925offRow 6, enter DATE OF INVOLVEMENT.TFLD_3_HELPdateoffwordwrapfixedcenterTYPINVL1_6ARREST1_68377349025offenter
CORROBORATION REQUESTED.Times New Roman10plainwordwrapfixedWAVDENY1CORRCVD182576010225offenter
CORROBORATION RECEIVED.Times New Roman10plainwordwrapfixedCORREQ1TORRFP176580816225offenter
TO AY F R O T C or R R F P.Times New Roman10plainwordwrapfixedCORRCVD1APPR133882898215offenter
REMARKS or COUNSELING.EntrywordwrapfixedSIGNATURE2483115120944offSIGNATURE OF AUTHORIZED REPRESENTATIVE. enter
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CERTIFICATION one.
Row 1, enter TYPE OF INVOLVEMENT, ORIGINAL CITATION.wordwrapfixedTimes New Roman9plainNAMEDTINVLV139348231440offRow 1, enter NAME AND ADDRESS OF ARRESTING AUTHORITY or COURT.wordwrapfixedTimes New Roman9plainDTINVLV1FINDING170848222340offRow 1, enter DISPOSITION, FINDING AND SENTENCE.wordwrapfixedTimes New Roman9plainARREST1TYPINVL1_23352123940offRow 2, enter TYPE OF INVOLVEMENT, ORIGINAL CITATION.wordwrapfixedTimes New Roman9plainFINDING1DTINVLV1_239352131440offRow 2, enter NAME AND ADDRESS OF ARRESTING AUTHORITY or COURT.wordwrapfixedTimes New Roman9plainDTINVLV1_2FINDING1_270852122340offRow 2, enter DISPOSITION, FINDING AND SENTENCE.wordwrapfixedTimes New Roman9plainARREST1_2TYPINVL1_33356023940offRow 3, enter TYPE OF INVOLVEMENT, ORIGINAL CITATION.wordwrapfixedTimes New Roman9plainFINDING1_2DTINVLV1_339356031440offRow 3, enter NAME AND ADDRESS OF ARRESTING AUTHORITY or COURT.wordwrapfixedTimes New Roman9plainDTINVLV1_3FINDING1_370856022340offRow 3, enter DISPOSITION, FINDING AND SENTENCE.wordwrapfixedTimes New Roman9plainARREST1_3TYPINVL1_43359923940offRow 4, enter TYPE OF INVOLVEMENT, ORIGINAL CITATION.wordwrapfixedTimes New Roman9plainFINDING1_3DTINVLV1_439359931440offRow 4, enter NAME AND ADDRESS OF ARRESTING AUTHORITY or COURT.wordwrapfixedTimes New Roman9plainDTINVLV1_4FINDING1_470859922340offRow 4, enter DISPOSITION, FINDING AND SENTENCE.wordwrapfixedTimes New Roman9plainTYPINVL1_53363823940offRow 5, enter TYPE OF INVOLVEMENT, ORIGINAL CITATION.wordwrapfixedTimes New Roman9plainFINDING1_4DTINVLV1_539363831440offRow 5, enter NAME AND ADDRESS OF ARRESTING AUTHORITY or COURT.wordwrapfixedTimes New Roman9plainDTINVLV1_5FINDING1_570863822340offRow 5, enter DISPOSITION, FINDING AND SENTENCE.wordwrapfixedTimes New Roman9plainARREST1_5TYPINVL1_63367723940offRow 6, enter TYPE OF INVOLVEMENT, ORIGINAL CITATION.wordwrapfixedTimes New Roman9plainFINDING1_5DTINVLV1_639367731440offRow 6, enter NAME AND ADDRESS OF ARRESTING AUTHORITY or COURT.wordwrapfixedTimes New Roman9plainDTINVLV1_6FINDING1_670867722340offRow 6, enter DISPOSITION, FINDING AND SENTENCE.wordwrapfixedTimes New Roman9plainARREST1_6DETNYES567681616WERE YOU DETAINED, CONFINED, OR PLACED ON PROBATION FOR ANY OF THE ABOVE?. check for
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