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Print FormCOUNTERINTELLIGENCE/HUMAN INTELLIGENCE APPLICANT ASSESSMENT AND SCREENING PROCEDURES1. All applicants for training will be reviewed by an assessment and a selection boardcomposed of Marine Intelligence, community Officers and specialist. The selection process is aStandardize Operating Procedure for the purpose of screening of prospectiveCounterintelligence/Human Intelligence (CI/HUMINT) applicants, in accordance with Appendix Aof Marine Corps Order 3850.1J.2. Before selection, the applicant will be requested to complete the applicant interviewform. Marine Intelligence personnel will interview the applicant's supervisors and contemporariesand review all service and other local records to determine suitability for assignment to CI/HUMINT duties. All CI/HUMINT applicants will submit as a part of their packages, the mostrecent medical screening form attesting to their current duty status. Lateral move applicants inareas where CI/HUMINT personnel are not readily available to convene a screening board, willbe screened as directed by the CMC (IOC).3. The following areas evaluate an applicant using Marine Corps standards of proficiency(i.e. OUTSTANDING, EXCELLENT, ABOVE AVERAGE, AVERAGE, BELOW AVERAGE,UNSATISFACTORY). The assessment and selection process consists of three phases,collectively combined to aide in the board's determination of an applicant's suitability for lateralmove and acceptance for the 0211 MOS. The screening process should determine the followingconcerning the applicant:a. Qualification per Chapter 1 of Marine Corps Order 3850.1J.b. Knowledge of the Marine Corps mission, organization, and functions.c. Knowledge of general military subjects.d. General appearance and bearing.e. Verbal and written expression.f. Knowledge of world affairs and current events.g. Motivation for applying for CI/HUMINT training.h. Apparent academic ability to successfully complete the formal course of instruction.4. A summary report of the screening board, including an appropriate recommendation,will be forwarded to the CMC (IOC) via the operational chain of command. This report will besubmitted on all applicants screening regardless of the recommendation. Appendix A of MCO3850.1J pertains. A copy of the board results will be provided to the screened applicant forsubmission of the lateral move/reenlistment package by the career planner to HQMC.5. Personnel selected for appointment to warrant officer (MOS 0210) must hold the 0211MOS, except where waived by the Director of Intelligence.NAVMC 11324 (Rev. 3-07) (EF)SN: 0000-00-888-0452Adobe Designer 8.0

COUNTERINTELLIGENCE/HUMAN INTELLIGENCE APPLICANT INTERVIEW FORMPRIVACY ACT STATEMENTNOTICE:Read the information relative to records system MIN 00001 published in theFederal Register and the following Privacy Act Statement before filling out this formUnder the authority of Title 5, U.S.C., Section 301, information regarding your social securitynumber and background is requested in order to determine your suitability and eligibility forassignment to counterintelligence/HUMINT duties. The information provided by you will become part ofthe Personnel Security Eligibility and Access Information System. The information provided by youwill not be divulged without your written authorization to anyone other than those officials andemployees in the performance of their official duties in accordance with the routine uses of thissystem of records. You are not required to provide this information; however, failure to do so couldresult in a denial for assignment to counterintelligence/HUMINT duties. (Data required by the PrivacyAct of 1974, 5 U.S.C. 552A.)Counterintelligence/HUMAN Intelligence Applicant Interview(LAST NAME, FIRST, M.I.)GRADESSNORGANIZATIONNAVMC 11324 (Rev. 03-07) (EF) PAGE 2Reset FormMOS

The following questions are to be answered by the applicant prior to appearing before theCounterintelligence/HUMINT Screening Board.1.Are you a United Statescitizen?DATE OF BIRTH:If yes, what is your wife's Place of BirthDATE OF BIRTH:NOYES2.PLACE OF BIRTHAre you married?NOYES3. Are all members of your immedicate family (i.e. father, mother, brothers/sisters, wife, andchildren) United States citizen?NOYES(If no, provide citizenship in remarks section.)TEST SCORES4.GT/GCTDate TestedScore5.Date TestedScoreDLAB6. Do you speak, read, or write a foreign language for which you have not been administered theappropriate DLPT test?NOYESa. If so, identify the language and how learned, and describe your proficiency in the remarks section.7.DLPT/LanguageDate TestedScore8. LIST EDUCATION COMPLETED:a. High Schoolc.GEDYears CompletedYear Completede. Graduate Programb.d.Years CompletedCollegeGraduateYears CompletedGraduateDegreeYESNO11. Number of dependentsNAVMC 11324 (Rev. 03-07) (EF) PAGE 3NOYESGraduateAA9. Are you now or have you previously taken off-duty education courses?(List courses in remarks section)10. Have you taken MCI courses?(List courses in remarks section)NOYESYESYESLocation of dependentsReset FormMastersBA/BSNONO

12. Are any members of your immediate family in poor health or that require constant services or the attention of adoctor?NOYES(If yes, explain in remarks section.)13. Do you or your spouse have any relatives residing in a foreign country?14.(If yes, give name, relationship, citizenship, and country of residence in remarksNOYESBriefly describe your jobDo you have a civilian off-duty job?NOYES15. Would your absence or separation from your family cause an unusual financial hardship on them?(If yes, briefly explain in remarks section)NOYES16. Have you ever received a letter of indebtedness through official channels?YESNO(If yes, give date, agency, amount, and present status of debt in remarks section.)17. Are you presently drawing any special pay?YESNO(If yes, describe in remarks section.)18. Have you ever been arrested, held, or charged by civil authorities for any crime or offense?YESNO(If yes, give details in remarks section.)19. Have you ever been court-martialed?YESNO(If yes, give details in remarks section.)20. Have you ever had a security clearance denied or revoked for cause?YESNO(If yes, give details in remarks section.)21. Do you presently have a securityclearance?NOYESa. Type of investigation completed.(SSBI/BI/NAC/ENTNAC/DATE/CCN)22. To the best of your knowledge, is there anything in your background that would preclude the granting of a TopSecret security clearance? (If yes, explain in remarks.)YESNO23. Have you ever illegally used drugs or narcotics?YESNO(If yes, explain in remarks section.)24. Do you use alcoholic beverages?YESNOIf yes, to what degree?Reset FormNAVMC 11324 (Rev. 03-07) (EF) PAGE 4

25. Are you now or have you ever been a member of a Communist or fascist organization or an organization whichadvocates the overthrow of our constitutional form of Government or advocates the denial of rights to others?(If yes, explain in remarks.)YESNOa. Have you ever associated with any members of such organizations?(If yes, explain in remarks.)YESNO26. Have you previously applied for counterintelligence/HUMINTtraining?NOYESa. If yes, when and where?27. Do you have a driver's license? (Classification/issuing agency)Date of expirationCivilian:Military:28. What was your last PFT score:Date?29. Have you ever had an MOS for which you trained at a formal school?YESNOIf yes, list MOS(s)a. Required School30. List all other military service and civilian schoolscompleted.b. Date31. Give a brief resume of your military history. (Date,organizations assigned, and duties performed.)(Date and title)33. AFADBDNAVMC 11324 (Rev. 03-07) (EF) PAGE 534. Date present enlistment ends.Reset Form

34. If selected for counterintelligence/HUMINT training, are you willing to extend your enlistment in order to have 3 yearsservice remaining upon completion of basic MOS training?NOYES35. If you should be trained and assigned to the counterintelligence/HUMINT field, are you prepared to acceptassignments which may require you to work after normal working hours, and which may be of a nature wherein youwould not not be able to discuss the details of your duties with your family or friends?YESNO36. Are you willing to submit to a Test for Espionage and Subversion (TES) polygraph examination?YESNO37. Explain your reasons for desiring to retrain in the counterintelligence/HUMINT field.I certify that all information provided by me above is true, complete, and current to the best of my knowledge andbelief and is made in good faith.(Signature of applicant)REMARKSNAVMC 11324 (Rev. 03-07) (EF) PAGE 6Reset Form

(On subsequent pages the applicant is requested to present a brief autobiography. Autobiography should be hand written inpassive voice - 3rd person. Autobiography can be continued on subsequent pages.)AUTOBIOGRAPHYNAVMC 11324 (Rev. 03-07) (EF) PAGE 7Reset Form