Fillable Printable Security Specialist Worksheet
Fillable Printable Security Specialist Worksheet
Security Specialist Worksheet
SECURITY SPECIALIST WORKSHEET
SUBJECT
POSITION SENSITIVITY BASIS SECURITY CLEARANCE
SF 189/312
TOP SECRET
NONE
CONFIDENTIAL
SECRET
SPECIAL CLEARANCE
COMMENTS
SECURITY SPECIALIST
CASE STATUS PENDING CLOSED
PERSONNEL SECURITY CHIEF
SECURITY OFFICER (Signature)
SI
DOE L
ICS
COSMIC
NATO
NRC Q
DOE Q
TK
4
1
2
3
ADJUNCTION
CLOSING APPROVAL
FREQUENCY
2 ISSUES
IN 0-36 MONTHS
RAISE ALL ISSUES TWICE
(e.g., "A" to "C"
RAISE BOTH ISSUES ONCE
(e.g., "A" to "B"
3 OR MORE
IN 0-36 MONTHS
ISSUE(S)
(1)
CONTROL
DATE
(2)
DATE OF
CONDUCT/
INCIDENT
(3)
TIME
ELAPSED
(1) - (2)
(4)
ISSUE
CHARACTER-
IZATION
(A, B, C, D)
(5)
UPGRADE
(6)
CONVERSION
UPGRADE ACTION
ISSUE
PERIOD IN WHICH ISSUE OCCURRED
CONVERTS
TO
B
D
C
B
0-36 MO.
C
B
A
37-72 MO.
B
A
NON-ISSUE
73-108 MO.
C
D
DATE
DATE
DATE
GENERAL SERVICES ADMINISTRATION
GSA 6027 (REV. 9/1990)
