ACKNOWLEDGMENT AND AGREEMENT
     TO PARTICIPATE IN THE PERSONNEL ASSURANCE PROGRAM (EXAMPLE)


 I, ___________ (applicant's/employee's full name), acknowledge that I am
seeking certification or recertification in the Personnel Assurance Program
(PAP).

 I recognize that the Department of Energy (DOE) has the highest interest of
national security and public health and safety in assuring that individuals
performing nuclear explosive duties meet the highest standards of human
reliability.

 I acknowledge that I have been advised of the requirements for performing
nuclear explosive duties.  I have also been advised of my responsibilities
under the PAP.  The PAP certification process including comprehensive
testing for drug use, alcohol abuse, physical capability, and mental
stability, have been fully explained to me.

 I hereby consent and agree to submit to all components under the PAP and
further consent and agree to cooperate fully with ___________________ and/or
the DOE in the assessment of my certification to a PAP position.


_____________________    _____________________________
Date                     Employee

     ______________________________
               Supervisor


                      REFUSAL OF CONSENT (EXAMPLE)

The requirements of the Personnel Assurance Program (PAP) have been
explained and I hereby decline to participate in the program.  I acknowledge
that this decision will result in my reassignment to other than nuclear
explosive duties, if available, and the termination of further processing of
my certification for the PAP.


__________________________    ____________________________
Date                          Employee

     ________________________________
               Supervisor