DD Form 2981 Basic Criminal History and Statement of Admission

What Is a DD Form 2981?

DD Form 2981, Basic Criminal History and Statement of Admission is a form used for collecting criminal record data and covers a five year period at the end of which a new form must be initiated.

The latest edition of the form - sometimes confused with the DA Form 2981, Application for Determination of Moral Eligibility for Induction - was released by the Department of Defense (DoD) in October 2018. A DD Form 2981 fillable version is available for download and digital filing below or can be found through the Executive Services Directorate website.

Each Department of Defense employee, DoD contractor, family child care provider, adult family member of a family child care provider, and specified volunteers of a DoD C&Y program must undergo a background check and annually self-report changes to their criminal history.

ADVERTISEMENT

How to Fill out a DD Form 2981?

The DD Form 2981 is used to verify that the employee in question has not been arrested, charged, or convicted by Federal, State, or other Law enforcement authorities for any violation of Federal laws, Military laws, State laws, County or Municipal laws, regulations or Ordinances, nor have they been arrested, charged or held by Federal, State or Other Law Enforcement Authorities for any crime or offense involving the following:

- Crimes involving children;

- Sex-related crimes;

- A drug or alcohol offense;

- Domestic violence;

- Violent crime or assaultive behavior, or other.

The statement itself consists of several fillable boxes and a section that provides an authorization and releases certification. DD Form 2981 instructions are as follows:

  1. Box 1 requires the applicant to provide their first, last and middle name in full. Initials or abridgments are prohibited.
  2. Box 2 is specifically for submitting any other names used by the applicant. This includes maiden names for women.
  3. Box 3 requires specifying the birthplace of the applicant, including the city, state, and country of birth.
  4. Box 4 is for providing the date of birth in MMDDYYYY format.
  5. Box 5 is for gender of the applicant.
  6. Applicants are required to specify the installation or DoD CY program chosen for employment or to volunteering in Box 6.
  7. Box 7 is for the date of hire. This is to be completed by CDP staff only.
  8. Box 8A requires the applicant to put an X in the appropriate box to signify if there has or hasn't been arrest, charging, or conviction by Federal, State, or other Law enforcement authorities for any violation of any Federal law, Military law, State law, County or Municipal law, Regulation or Ordinance.These do not include any kind of breaches of law that happened before the age of 16. This also leaves off traffic fines of up to $300.
  9. Box 8B is filled in case the Box8A was answered positively. Box 8B is divided into 6 columns meant for providing all specifics to any arrests, charges, or convictions. An X must be placed in the appropriate box if there was arrest for a crime or offense involving any of the following: a child, a sex-related crime, drug or alcohol abuse, domestic violence, violent crime and assaultive behavior, or other. Failure to provide information may result in an unfavorable adjudication decision. All other charges must be included in the space provided below, even if they were dismissed. Positive answers require an explanation. Block 10 can be used if additional space is needed.
  10. Box 9 requires filing on an annual basis. An X must be put in the appropriate box indicating if any new arrests or charges occurred in regard to anything mentioned in Box 8.
  11. Block 10 is left for any additional notes.

Does the DD Form 2981 Need to Be Completed by Minors?

In short: no. Minors under the age of 18 can do strictly unpaid volunteer work for the Department of Defense. Unpaid volunteering is not a form of employment. It does call for its own background check done through a separate set of forms.

OMB No. 0704-0516
BASIC CRIMINAL HISTORY AND STATEMENT OF ADMISSION
OMB approval expires:
(Department of Defense Child Care Services Programs)
September 30, 2021
The public reporting burden for this collection of information, OMB Control Number 0704-0516, is estimated to average 15 minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall
be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PRIVACY ACT STATEMENT
AUTHORITY:
Manual 1402.05, Background Checks on Individuals in Department of Defense Child Development and Youth Programs.
PRINCIPAL PURPOSE(S): To require individuals who come into regular, reoccurring contact with children under the age of 18 years to self-report any arrests, charges or convictions
include impacted individuals such as employees, DoD contractors, family child care providers, adults residing in a family child care home, volunteers, and others with regular reoccurring
contact with children. Individuals who work or volunteer in DoD Child Development and Youth Programs must annually self-report changes to his or her status utilizing this form. All
individuals required to complete this form must immediately self-report to their employer/supervisor if they are arrested, charged, convicted, or met criteria for any offense listed on the
form. When completed, records are covered by one of the appropriate SORNs:
Army: http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/570012/a0215-fmwrc.aspx
Navy: http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/570428/nm01754-3.aspx
Air Force: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569755/f034-af-sva-c/
ROUTINE USES: This form will be initiated by DoD staff and will be maintained in the initiating DoD offices and/or appropriate Human Resources or Security Offices. Information
received as a result of this release may be used to assess interim/on-going or final suitability or fitness for DoD personnel working with children. ONLY DoD Child Development and
http://
dpcld.defense.gov/Privacy/SORNsIndex/Blanket-Routine-Uses/
may apply to these records.
DISCLOSURE: Voluntary; however, failure to furnish all requested information may result in an unfavorable adjudication decision and may affect suitability/fitness.
1. NAME
2. OTHER NAME(S) USED
(Last, First, and Middle Name) (Do not use initials or abridgements.)
3. DATE OF BIRTH
4. INSTALLATION/PROGRAM NAME
(MM/DD/YYYY)
5. DATE OF HIRE
6. Have you been arrested, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law, Military law, State law, County or
Municipal law, or met the Family Advocacy criteria for child maltreatment? (Do not include anything that happened before your 16th birthday. Leave out traffic
fines of less than $300.) (X one)
of the form in block 9.
CHILD ABUSE/
VIOLENT CRIME/
Yes
No
Yes
No
DRUG OR ALCOHOL:
Yes
No
NEGLECT:
ASSAULTIVE BEHAVIOR:
SEX CRIME:
Yes
No
DOMESTIC VIOLENCE:
Yes
No
(1) MONTH/
(3) ACTION
(4) COURT
(5)
(2) OFFENSE
(6) ZIP CODE
YEAR
TAKEN
(City & Country if outside the United States)
STATE
7. I certify that the information provided above is accurate. I understand that I must immediately report to my employer/supervisor or Child and Youth Program
representative if I am arrested, charged, convicted, or met criteria for any offense referenced in block 6.
a. SIGNATURE
b. DATE
(YYYYMMDD)
8. ANNUAL CERTIFICATIONS (Required by Child Development and Youth Program Staff and Volunteers)
In the past year, have you been arrested, apprehended, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law,
Military law, State law, County or Municipal law or met the Family Advocacy criteria for child maltreatment.
Failure to disclose accurate information may be grounds for dismissal, termination, or disbarment from participating in the program.
a. 2nd YEAR
(1) SIGNATURE
(2) DATE
b. 3rd YEAR
(1) SIGNATURE
(2) DATE
(Yes or No)
(YYYYMMDD)
(Yes or No)
(YYYYMMDD)
c. 4th YEAR
(1) SIGNATURE
(2) DATE
d. 5th YEAR
(1) SIGNATURE
(2) DATE
(Yes or No)
(YYYYMMDD)
(Yes or No)
(YYYYMMDD)
Failure to provide information may result in an unfavorable adjudication decision.
DD FORM 2981, OCT 2018
Page 1 of 3
PREVIOUS EDITION IS OBSOLETE.
OMB No. 0704-0516
BASIC CRIMINAL HISTORY AND STATEMENT OF ADMISSION
OMB approval expires:
(Department of Defense Child Care Services Programs)
September 30, 2021
The public reporting burden for this collection of information, OMB Control Number 0704-0516, is estimated to average 15 minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall
be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PRIVACY ACT STATEMENT
AUTHORITY:
Manual 1402.05, Background Checks on Individuals in Department of Defense Child Development and Youth Programs.
PRINCIPAL PURPOSE(S): To require individuals who come into regular, reoccurring contact with children under the age of 18 years to self-report any arrests, charges or convictions
include impacted individuals such as employees, DoD contractors, family child care providers, adults residing in a family child care home, volunteers, and others with regular reoccurring
contact with children. Individuals who work or volunteer in DoD Child Development and Youth Programs must annually self-report changes to his or her status utilizing this form. All
individuals required to complete this form must immediately self-report to their employer/supervisor if they are arrested, charged, convicted, or met criteria for any offense listed on the
form. When completed, records are covered by one of the appropriate SORNs:
Army: http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/570012/a0215-fmwrc.aspx
Navy: http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/570428/nm01754-3.aspx
Air Force: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569755/f034-af-sva-c/
ROUTINE USES: This form will be initiated by DoD staff and will be maintained in the initiating DoD offices and/or appropriate Human Resources or Security Offices. Information
received as a result of this release may be used to assess interim/on-going or final suitability or fitness for DoD personnel working with children. ONLY DoD Child Development and
http://
dpcld.defense.gov/Privacy/SORNsIndex/Blanket-Routine-Uses/
may apply to these records.
DISCLOSURE: Voluntary; however, failure to furnish all requested information may result in an unfavorable adjudication decision and may affect suitability/fitness.
1. NAME
2. OTHER NAME(S) USED
(Last, First, and Middle Name) (Do not use initials or abridgements.)
3. DATE OF BIRTH
4. INSTALLATION/PROGRAM NAME
(MM/DD/YYYY)
5. DATE OF HIRE
6. Have you been arrested, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law, Military law, State law, County or
Municipal law, or met the Family Advocacy criteria for child maltreatment? (Do not include anything that happened before your 16th birthday. Leave out traffic
fines of less than $300.) (X one)
of the form in block 9.
CHILD ABUSE/
VIOLENT CRIME/
Yes
No
Yes
No
DRUG OR ALCOHOL:
Yes
No
NEGLECT:
ASSAULTIVE BEHAVIOR:
SEX CRIME:
Yes
No
DOMESTIC VIOLENCE:
Yes
No
(1) MONTH/
(3) ACTION
(4) COURT
(5)
(2) OFFENSE
(6) ZIP CODE
YEAR
TAKEN
(City & Country if outside the United States)
STATE
7. I certify that the information provided above is accurate. I understand that I must immediately report to my employer/supervisor or Child and Youth Program
representative if I am arrested, charged, convicted, or met criteria for any offense referenced in block 6.
a. SIGNATURE
b. DATE
(YYYYMMDD)
8. ANNUAL CERTIFICATIONS (Required by Child Development and Youth Program Staff and Volunteers)
In the past year, have you been arrested, apprehended, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law,
Military law, State law, County or Municipal law or met the Family Advocacy criteria for child maltreatment.
Failure to disclose accurate information may be grounds for dismissal, termination, or disbarment from participating in the program.
a. 2nd YEAR
(1) SIGNATURE
(2) DATE
b. 3rd YEAR
(1) SIGNATURE
(2) DATE
(Yes or No)
(YYYYMMDD)
(Yes or No)
(YYYYMMDD)
c. 4th YEAR
(1) SIGNATURE
(2) DATE
d. 5th YEAR
(1) SIGNATURE
(2) DATE
(Yes or No)
(YYYYMMDD)
(Yes or No)
(YYYYMMDD)
Failure to provide information may result in an unfavorable adjudication decision.
DD FORM 2981, OCT 2018
Page 1 of 3
PREVIOUS EDITION IS OBSOLETE.
BASIC CRIMINAL HISTORY AND STATEMENT OF ADMISSION
(Department of Defense Child Care Services Programs)
9. NOTES (Use this space to enter additional comments.)
10. AUTHORIZATION AND RELEASE CERTIFICATION
I hereby authorize the Department of Defense and other authorized federal agencies to obtain any information required from the Federal
government, and/or state agencies, and/or foreign governments, including but not limited to, the Federal Bureau of Investigation (FBI), the
Defense Investigation Service (DIS), the U.S. Office of Personnel Management (OPM), the Department of Homeland Security (DHS), (if
applicable), and from the State Criminal History Repository for each state where I have resided. This authorization is valid for one year from
the date this form was signed or upon termination of my affiliation with the Federal Government, whichever is sooner.
affiliation with DoD Child Care Services Programs. I understand that I may request a copy of such records as may be available to me under
the law. I understand that I have a right to challenge the accuracy and competencies of any information contained in the criminal history
records check report. I also understand that pursuant to the Privacy Act, the information collected will be confidential, and disclosure limited to
purposes authorized under the Privacy Act - mainly to conduct the background check.
I release any individual, including records custodians, any component of the United States Government or the individual State Criminal
History Repository supplying information, from all liability for damages that may result on account of compliance, or any attempts to comply
with this authorization. This release is binding, now and in the future, on my heirs, assigns, associates, and personal representative(s) of any
nature. Copies of this authorization that show my signature are as valid as the original release signed by me.
WARNING: False statements are punishable by law and could result in fines and/or imprisonment for up to five years.
a. SIGNATURE
b. DATE SIGNED
(YYYMMDD)
DD FORM 2981, OCT 2018
Page 2 of 3
PREVIOUS EDITION IS OBSOLETE.
INSTRUCTIONS
This Department of Defense Form is to be completed by prospective employees, volunteers, DoD Contractors, FCC providers, and adults
residing in the home upon application for any position within a Department of Defense Child Care Services Programs. The form will be
utilized for initial certification that said individual has not been arrested, charged, or convicted by Federal, State, or other Local authorities for
any violation of any Federal law, Military law, State law, County or Municipal law, Regulation or Ordinance, nor have they been arrested,
charged or held by Federal, State or Local Authorities for any crime or offense involving any of the following: Crime involving a child, sex
crime, drug or alcohol offense, domestic violence, violent crime/assaultive behavior, or other. Employees and volunteers of DoD Child
Development and Youth Programs must update this form on an annual basis.
Completion of this form is voluntary; however, failure to furnish all requested information may result in an unfavorable adjudication decision
and may affect suitability of working with or around children.
1. Provide your last, first and middle name. Do not use initials or abridgements.
2. Provide any other names used to include maiden name.
3. Provide your date of birth in YYYYMMDD format.
4. Provide the installation or DoD program where you seek employment or to volunteer; if operating a FCC program, or residing in a
FCC home, provide the location of the FCC home.
5. Provide the date of hire.
6. Place an X in the appropriate box if you have or have not been convicted by Federal, State, or local authorities for any violation
of any Federal law, Military law, State law, County or Municipal law, Regulation or Ordinance, or met the Family Advocacy criteria for child
maltreatment? (Do not include anything that happened before your 16th birthday. Leave out traffic fines of less than $300.)
If additional space is needed, use block 9.
7. Sign and Date.
8. On an annual basis, circle the appropriate response indicating if you have been arrested, apprehended, charged, or convicted by Federal,
State, or local authorities for any violation of any Federal, Military, State or local Authorities or met the Family Advocacy criteria for child
maltreatment. Applies to employees and volunteers of DoD Child Development and Youth Programs.
9. Use this space for additional comments, if needed, for Blocks 6 and 8.
e.
10. Sign and dat
DD FORM 2981, OCT 2018
Page 3 of 3
PREVIOUS EDITION IS OBSOLETE.

Download DD Form 2981 Basic Criminal History and Statement of Admission

1204 times
Rate
4.4(4.4 / 5) 58 votes
ADVERTISEMENT
Page of 3