LIVE SCAN CONSENT FOR ENLISTMENT The proponent for this form is ARNG-HRR. For use of this form, see Accession Options Criteria.

PRIVACY ACT STATEMENT AUTHORITY: Title 10 USC Section 503, Enlistments: recruiting campaigns. PRINCIPLE PURPOSE(s): The purpose of this form is to obtain consent of applicant’s fingerprints prior to enlistment to prevent fraudulent entry. Applicants are required to disclose information in the questions listed. ROUTINE USE(s): This form is only used when an applicant agrees for processing at the MEPS. DISCLOSURE: VOLUNTARY, failure to agree to fingerprint collection could result in inability to process for enlistment.

Name: PRID:

The applicant processing for enlistment must understand fingerprinting is a requirement for processing the background investigation for entry into the Army National Guard. With the completion of this document, the applicant does consent to the capturing and transmitting of fingerprints to the U.S. Office of Personnel Management (OPM) and the Federal Bureau of Investigations (FBI), for the purpose of processing an investigation. Refusal to have fingerprints processed for a background investigation, may result in inability to process for enlistment.

It is the policy of the Army National Guard, that applicants for enlistment disclose all activity with law enforcement and court officials, regardless of the disposition of the case. All incidents with law enforcement agencies will be listed below, regardless of whether the applicant was arrested, charged, cited, held, or detained in any way by any Local, State, or Federal agency, including Juvenile Authorities, Police Officers, Sheriff, Department of Natural Resources, Fish and Game Wardens, Military Police, etc.

Recruiters will ask each applicant the following questions and select the appropriate answer. All yes answers require an explanation in the remarks section and for all law enforcement incidents list the following details: approximate date of the offense(s); City, County and State of the police and court(s); and the disposition or outcome. Prior service applicants must list all violations that occurred prior to, during and/or after enlistment into military service. For applicants who answer no to all questions, the remarks page is not required.

Questions related to an applicant’s history. Yes No

1. Have you ever been arrested, detained or interviewed as suspect by any law enforcementagency, issued a summons, citation, or ticket by any law enforcement agency, or required toperform any type of conditions by police or court officials regardless of disposition of the case?2. Have you ever been fingerprinted for any reason?

3. Have you been told by a lawyer, Judge, Prosecutor, Recruiter, Family Member, Friend orProbation Officer not to disclose your law violation because the offense would not show up on abackground check or because it has been removed, expunged, set aside or sealed?4. Have you ever entered into any type of program that would remove the charge(s) aftercompletion of the program? (for example: Diversion, Deferred Prosecution, Pre-Trial Intervention,ordered to take classes, Community Service, write a letter, etc.)5. Have you ever had any governmental agency (Police, Sheriff, Game Warden, etc.),impose penalties on you so the offense would not be filed, or told that the offense will goaway as if it never happened?6. Would you have answered yes to any question above, but were told to answer NO due topolice or court record checks processed by your Recruiter prior to being fingerprinted?7. If you have ever served in any component of the U.S. Military, Active or Reserve, have youever received UCMJ action, including Article-15, Captain’s Mast, Court Marshal, Official orUnofficial letter of Reprimand?8. Have you ever been suspended from, or served detention in any school for any reason?

Recruiter Name Recruiter Signature Date

HRR Form 369 PREVIOUS VERSIONS ARE OBSOLETE Page 1 of 2

Remarks.

I verify that all Yes answers have been listed on this form and are true and accurate to the best of my knowledge. Recruiter name Recruiter signature Date

HRR Form 369 (Back) PREVIOUS VERSIONS ARE OBSOLETE Page 2 of 2