DEFENSE SECURITY SERVICE

Personnel Security Management Office for Industry

7556 Teague Road, Suite 500
Hanover, MD 21076

CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Ms. Jane Q. Smith
Facility Security Officer
American Widget Company, LLC.
1700 K Street NW Suite 500
Washington, DC 22205

15 NOV 2014

Dear Ms. Smith:

Your request for security eligibility for Mr. John J. Rambo, SSN: 123-45-6789, has been referred to the
Defense Office of Hearings and Appeals (DOHA), P.O. Box 3656, Arlington, Virginia 22203-1995.
Please deliver the enclosed sealed envelope, unopened, personally to Mr. Rambo, and have him complete
the receipt at the bottom of this page. Then you should return the receipt to DOHA in the enclosed
addressed envelope. DOHA must have proof that Mr. Rambo has received this envelope.
If Mr. Rambo is no longer employed by your company or if he does not require a security eligibility for
access to any level of classified information, please return the enclosed envelope, unopened, directly to
DOHA and provide the date of termination of employment or an explanation that security eligibility is no
longer required at any level.
If you have any questions about this letter, please telephone our DoD Security Call Center on (888) 2827682.
Sincerely,

Anthony J Cannamela Jr
Division Chief, Personnel Security Management Office for Industry (PSMO-I)
------------------------------------------------------------------------------RECEIPT

John J Rambo

______________________________
EMPLOYEES SIGNATURE

EMPLOYEES PRINTED NAME:

EMPLOYEES SSN:
EMPLOYEES CURRENT ADDRESS:

______________________________
15 DEC 2014
DATE

____________________________________
John J. Rambo
_____________________________________
123-45-6789
______________________________________
Fort Bragg, North Carolina