DA Form 2801. Polygraph Examination Statement of Consent

The DA Form 2801, also known as the Polygraph Examination Statement of Consent, is used by the Department of Army to obtain consent from individuals required to undergo a polygraph examination. This form serves as an agreement between the individual and the Army, outlining the purpose and conditions of the examination.

The form consists of important fields such as personal information (name, rank, social security number), consent for the examination, and a statement acknowledging that the individual understands the potential use of the polygraph results in criminal or administrative actions. It is crucial for individuals to carefully read and understand the form before signing, as it grants permission for the Army to administer the polygraph examination.

Application Example: The DA Form 2801 is utilized when individuals apply for security clearances that require a polygraph examination. By signing this form, they acknowledge the importance of the examination in determining their eligibility for clearance and provide their informed consent for the process.