EFTA00173921.pdf

InfraGard Application 10387512 Submitted: 02/16/2020 Sotirios Triantafillou Chapter: South Florida Members Alliance Personal Information 1163 NE 3rd Ave Boca Raton, FL 33432 Home: 561-757-5711 Cell: 561-617-6030 Email: [email protected] Birth Date: 05/05/1972 Citizen By Birth Citizenship Documentation: Passport Nbr: 541572839 Date Issued: 08-MAR-16 Expired: Citizenship Cert Nbr: Date Issued: Location: Naturalization Nbr: Date Issued: Location: DoS Document Nbr: Date Completed: Issue Location: Birth: chicago, IL Country: Drivers License: T653780721650(FL) SSN: 345-70-7026 Helpdesk Code Word: Derby Business Information Derby Cybersecurity LLC 1163 NE 3rd Ave Boca Raton, FL 33432 Title: Managing Partner Phone: 561-757-5711 Fax: Email: [email protected] Website: Fax: Additional Information Critical Infrastructure: Information Technology 1 EFTA00173921  InfraGard Do you or have you had a security clearance? No Have you applied for InfraGard membership before and been denied? No Were you previously an InfraGard member? No Have you ever been arrested for, charged with, OR convicted of a felony or misdemeanor, even if expunged from your record? Yes A DUI 20 years ago in Illinois in the town of Glenview Have you ever served in the military? No Were you discharged from the military? Were you ever subject of a court martial while in the military? No Are you unemployed? No Other organizations you are affiliated with: People Centered Internet - Washington DC chapter Why do you want to join InfraGard? Assist with the Protection of U.S. Critical Infrastructure; Networking; Attend Meetings; Access IG Network; Access iGuardian; Participate on National or Local Board How did you hear about infraGard? Colleague 2 EFTA00173922  InfraGard Standardized Record Checks for InfraGard Applicants APPLICANT INFORMATION Name: Sotirios Triantafillou DOB: 05/05/1972 SSN: 345-70-7026 CLEARANCE CHECK (SCATTERED CASTLES or JPAS) Conducted by: Date: Applicant Response: No Results: CITIZENSHIP CHECK Conducted by: Date: Applicant Response/POB: Citizen By Birth i chicago. IL, Results: DRIVER'S LICENSE CHECK & PHOTO Conducted by: I Date: I DL(State): T653780721650(FL) Results: COMPLETE CRIMINAL HISTORY (NCIC, III, Wants and Warrants, and State Records) Conducted by: CJIS Date: 02/19/2020 Results: CJIS / NCIC: No Hits CJIS / Ill: Record Name: TRIANTAFILLOU,SOTIRIOS, Record DOB: Charges: 12/10/2000:IL0163900 GLENVIEW POLICE DEPARTMENT GLENVIEW:DUI/ALCOHOL DIVS(SENTINEL AND LEGACY ACS) Conducted by: Date: Results: MILITARY SERVICE (if necessary) Conducted by: Date: Applicant Response: No Results: KNOWN CONCEALED CARRY PERMIT (Office Discretion) Conducted by: Date: Yes No ❑ Application Meets Standards for Approval, document to Sentinel ❑ Recorded in IGN n Approve with derogatory information, see FD-1057 ❑ Deny, see FD-1057 Date Reviewing Authority 3 EFTA00173923