U.S. DOD Form dod-eng-3544
PERSONAL SECURITY STATEMENT
(USACE Supplement 1 to AR 380-5)
I,
, cleared for access to classified
(NAME OF INDIVIDUAL)
information up to and including
do hereby sign this
(DECREE OF CLEARANCE)
statement as evidence that I have read applicable paragraphs in AR 380-5, AR 380-13, AR 530-1, and
other pertinent regulations and local implementing instruction pertaining to my position, and
I understand that I am required to read all changes and revisions thereto as they occur.
I understand that I am to familiarize myself annually with these regulations.
I understand that to the best of my ability I must at all times comply with the rules and regulations
I have been required to read.
I am cognizant of my responsibilities relative to security, and I will properly safeguard all classified
information that is entrusted to me during my employment with or assignment to
(INSTALLATION OR ACTIVITY)
FOR ANNUAL ANNOTATIONS
SIGNATURE OF INDIVIDUAL
ENG FORM 3544, Jul 79
DATE
EDITION OF JAN 73 IS OBSOLETE.
(Proponent: CEPM-S)