DA Form 7769 Foreign Government Employment Application

DA Form 7769 - also known as the "Foreign Government Employment Application" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 7769 - was last revised on November 1, 2016. Download an up-to-date fillable PDF version of the DA 7769 down below or look it up on the Army Publishing Directorate website.

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FOREIGN GOVERNMENT EMPLOYMENT APPLICATION
For use of this form, see AR 600-291; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
PRINCIPAL PURPOSE:
To provide information from applicants in accordance with AR 600-291.
The DoD Blanket Routine Uses may apply to this collection.
ROUTINE USES:
Disclosure of personally identifiable information is voluntary. However, failure to provide identifying information may delay
DISCLOSURE:
processing of this application.
Section I - APPLICANT DATA
Name (Last, First, MI)
Grade/Rank(at retirement)
DOB
Place of Birth (City/State)
Military Retirement Date (if applicable)
Telephone
E-mail
Physical Address (include mailing if different)
Section II - INFORMATION/QUESTIONNAIRE
1. Who is your proposed employer and how are they connected to a foreign government?
2. What is your proposed job title?
3. What will your job duties involve? If a job description is available, please attach
4. Disclose all forms of benefits you will receive (pay, allowances, housing, transportation, consultation fees, etc.) for your services?
5. Are you a U.S. citizen?
6. Will you be required to execute an oath of allegiance to the foreign government with which you are working or to alter your U.S. citizen status?
7. What is the highest U.S. security clearance you have held?
8. What is the highest level of classified material to which you have been granted access?
9. Have you had access to Special Access Programs?
10. Will you work with classified information as part of your foreign employment? If yes, please explain.
11. Have you ever worked on matters involving this foreign country as part of your uniformed service duties? If yes, please explain.
12. Have you held any positions in the uniformed service that are relevant to your employment with the foreign government? If yes, please explain.
13a. Do you have knowledge of or previous access to technical data or software (classified/unclassified) related to the design, development, production,
manufacture, etc. of defense articles? If yes, please describe ways in which such information may be of use in your potential job.
b. If applicable, has your employer or have you applied for and received an export license for the defense services that you are offering (exceptions must
be approved by Department of State).
14. Have you ever had any adverse actions? If yes, please explain.
I hereby acknowledge that I am unaware of any reason why the above described foreign employment would be inadvisable or reflect unfavorably on the
United States. I also acknowledge and understand that my retired or retainer pay may be withheld equal to the amount received from the foreign government
if I accept employment before obtaining proper approval. I affirm that the above questions have been reviewed carefully and answered fully and correctly to
the best of my knowledge.
a. SIGNATURE
(YYYYMMDD)
b. DATE
APD LC v1.00ES
DA FORM 7769, NOV 2016
FOREIGN GOVERNMENT EMPLOYMENT APPLICATION
For use of this form, see AR 600-291; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
PRINCIPAL PURPOSE:
To provide information from applicants in accordance with AR 600-291.
The DoD Blanket Routine Uses may apply to this collection.
ROUTINE USES:
Disclosure of personally identifiable information is voluntary. However, failure to provide identifying information may delay
DISCLOSURE:
processing of this application.
Section I - APPLICANT DATA
Name (Last, First, MI)
Grade/Rank(at retirement)
DOB
Place of Birth (City/State)
Military Retirement Date (if applicable)
Telephone
E-mail
Physical Address (include mailing if different)
Section II - INFORMATION/QUESTIONNAIRE
1. Who is your proposed employer and how are they connected to a foreign government?
2. What is your proposed job title?
3. What will your job duties involve? If a job description is available, please attach
4. Disclose all forms of benefits you will receive (pay, allowances, housing, transportation, consultation fees, etc.) for your services?
5. Are you a U.S. citizen?
6. Will you be required to execute an oath of allegiance to the foreign government with which you are working or to alter your U.S. citizen status?
7. What is the highest U.S. security clearance you have held?
8. What is the highest level of classified material to which you have been granted access?
9. Have you had access to Special Access Programs?
10. Will you work with classified information as part of your foreign employment? If yes, please explain.
11. Have you ever worked on matters involving this foreign country as part of your uniformed service duties? If yes, please explain.
12. Have you held any positions in the uniformed service that are relevant to your employment with the foreign government? If yes, please explain.
13a. Do you have knowledge of or previous access to technical data or software (classified/unclassified) related to the design, development, production,
manufacture, etc. of defense articles? If yes, please describe ways in which such information may be of use in your potential job.
b. If applicable, has your employer or have you applied for and received an export license for the defense services that you are offering (exceptions must
be approved by Department of State).
14. Have you ever had any adverse actions? If yes, please explain.
I hereby acknowledge that I am unaware of any reason why the above described foreign employment would be inadvisable or reflect unfavorably on the
United States. I also acknowledge and understand that my retired or retainer pay may be withheld equal to the amount received from the foreign government
if I accept employment before obtaining proper approval. I affirm that the above questions have been reviewed carefully and answered fully and correctly to
the best of my knowledge.
a. SIGNATURE
(YYYYMMDD)
b. DATE
APD LC v1.00ES
DA FORM 7769, NOV 2016

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