Export Control Status Verification



NORTHROP GRUMMAN HUMAN RESOURCES USE ONLYSUBMISSION DATE (MM/DD/YYYY)MyIDCASE NO. FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ? FORMTEXT ?The purpose of this form is to assist in verifying your export control status. U.S. laws and regulations prohibit the unauthorized export of restricted technology to foreign persons. To comply with these legal requirements, Northrop Grumman must ascertain whether an individual who may be given access to restricted technology is a “foreign person” subject to these export control restrictions. Regardless of individual status, persons directly employed by an entity not organized or incorporated in the U.S., including Northrop Grumman affiliates, will be treated as foreign persons for purposes of access to restricted technology. Other security restrictions will also apply to foreign persons.Certain categories of persons, referred to as "U.S. persons" who are employed by U.S entities, are not considered foreign persons and do not need export licenses before being allowed access to restricted technology. Under U.S. export control laws, a "U.S person" is any of the following: (a) a U.S. citizen; (b) a Lawful Permanent Resident (i.e., "Green Card" holder); (c) a non-citizen U.S. national (a person born in American Samoa or Swains Island); (d) an alien who has been admitted to the United States as a refugee, or (e) an alien who has been granted asylum. The list of documents contained in section 1 should be used to verify someone is a U.S. person. If an individual whose export control status is being verified furnishes a document from the list in section 1 and indicates their employer is incorporated or organized in the U.S. in section 3, the individual is a U.S. person for export control purposes, and does not need an export license before being given access to restricted technology. All others are considered foreign persons and are only provided access to restricted technology with appropriate U.S. government authorization.INSTRUCTIONS1. Review and complete either section 1 or 2 (as appropriate), sign, and date. You are required to furnish original documents, except where noted. 2. Additionally, if you are any of the following, you are required to complete section 3: an external partner, contractor, consultant, supplier, long-term contract labor, or an employee of a Northrop Grumman affiliate not incorporated in the U.S.3. A company Human Resources representative, or trained designee, inspects the documents, verifies the accuracy of the information provided below, and completes the Certification section. The U.S. Citizenship and Immigration Services has a website with copies of each form to assist with verification.SECTION 1 – Only complete Section 1 if you are a U.S. person and can present one of the listed documents. LEGAL NAME FORMTEXT ?????SIGNATUREDATE FORMTEXT ?????COUNTRY OF CITIZENSHIP FORMTEXT ?????COUNTRY OF RESIDENCE FORMTEXT ?????DUAL CITIZENSHIP? FORMCHECKBOX YES FORMCHECKBOX NO IF YES, LIST ALL OTHER COUNTRIES: FORMTEXT ?????U.S.CITIZENSNON U.S.CITIZENS FORMCHECKBOX Unexpired or Expired United States passport or passport card FORMCHECKBOX Certificate of United States citizenship (USCIS Form N-560 or N-561) FORMCHECKBOX Certificate of naturalization (USCIS Form N-550 or N-570) FORMCHECKBOX Certificate of birth abroad issued by the U.S. Department of State (Form FS-545 or DS-1350) or Report of Birth Abroad (FS-240) FORMCHECKBOX Original or certified copy of a birth certificate issued by a state, county, municipal authority, or outlying possession of the United States, bearing an official seal FORMCHECKBOX Unexpired re-entry permit (USCIS Form I-327) FORMCHECKBOX Unexpired refugee travel document (USCIS Form I-571) FORMCHECKBOX Unexpired Alien registration receipt card with photograph (USCIS Form I-551) FORMCHECKBOX Unexpired foreign passport with I-551 stamp-7620010287000NORTHROP GRUMMAN HUMAN RESOURCES USE ONLYSUBMISSION DATE (MM/DD/YYYY)MyIDCASE NO. REF m1 \h REF m2 \h REF d1 \h REF d2 \h REF y1 \h REF y2 \h REF y3 \h REF y4 \h REF myid1 \h \* MERGEFORMAT REF myid2 \h \* MERGEFORMAT REF myid3 \h \* MERGEFORMAT REF myid4 \h \* MERGEFORMAT REF myid5 \h \* MERGEFORMAT REF myid6 \h \* MERGEFORMAT REF c1 \h \* MERGEFORMAT REF c2 \h \* MERGEFORMAT REF c3 \h \* MERGEFORMAT REF c4 \h \* MERGEFORMAT REF c5 \h \* MERGEFORMAT REF c6 \h \* MERGEFORMAT REF c7 \h \* MERGEFORMAT REF c8 \h \* MERGEFORMAT LEGAL NAME FROM SECTION 1 (IF APPLICABLE) REF ln \h SECTION 2 – Only complete Section 2 if you are a non-U.S. person and did not complete Section 1 LEGAL NAME FORMTEXT ?????SIGNATUREDATE FORMTEXT ?????COUNTRY OF CITIZENSHIP FORMTEXT ?????COUNTRY OF BIRTH FORMTEXT ?????DUAL CITIZENSHIP? FORMCHECKBOX YES FORMCHECKBOX NO IF YES, LIST ALL OTHER COUNTRIES: FORMTEXT ?????DOCUMENT ESTABLISHING COUNTRY OF CITIZENSHIP FORMTEXT ?????SECTION 3 – Only complete Section 3 if you are any of the following:Employees of Northrop Grumman affiliates not incorporated in the U.S. Long Term Contract Labor (contract at least one year)External Partners (Contractors/Consultants/Suppliers) FORMCHECKBOX CHECK IF ANY OF THESE OPTIONS APPLY TO YOULEGAL NAME OF EMPLOYER (COMPANY/AGENCY) FORMTEXT ?????IS YOUR DIRECT COMPANY/AGENCY EMPLOYER (NOT PARENT OR SUBSIDIARY) INCORPORATED/ ORGANIZED TO DO BUSINESS IN THE U.S. FORMCHECKBOX YES FORMCHECKBOX NO IF NO, WHERE FORMTEXT ?????COUNTRY OF INCORPORATION/ORGANIZATION OF EACH SUCH COMPANY/AGENCY REPRESENTED FORMTEXT ????? IF YES, ARE YOU CURRENTLY REPRESENTING ANY OTHER COMPANY/AGENCY FORMCHECKBOX YES FORMCHECKBOX NO IF YES, OTHER COMPANY/AGENCY REPRESENTED (LIST ALL) FORMTEXT ?????CERTIFICATION - To be completed by company Human Resources, or trained designee I certify that this form has been completed in accordance with the instructions and is true and correct to best of my knowledge and belief. I have examined the identity documents presented by the individual and confirm they reasonably appear to be genuine and relate to the individual named.Based on the information provided and reviewed, the individual’s export control status is: FORMCHECKBOX US Person FORMCHECKBOX Foreign Person subject to export control restrictionsLEGAL NAME FORMTEXT ?????SIGNATUREDATE FORMTEXT ?????TITLE FORMTEXT ?????MyID (IF APPLICABLE) FORMTEXT ?????-2857570485000 ................
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