All candidates must receive medical and security clearances in order to be hired and serve abroad.

Medical Clearance

The Office of Medical Services of the Department of State determines a candidate’s medical fitness and ability to serve overseas. Many Foreign Service posts are located in remote areas with extremely limited medical support; therefore, each candidate must meet rigorous medical standards in order to qualify for the required worldwide medical clearance. Medical clearance determination by Medical Services is based on its thorough review of each candidate’s medical history and physical examination, including an individual assessment of his/her specific medical needs and the medical capabilities of Foreign Service posts to meet those needs. All children under six must have their medicals done by their pediatrician.

After receiving a Conditional Offer of employment, each candidate is provided with the necessary examination forms (with instructions) to give to the examining health care practitioner (MD, DO, NP, PA). We also provide an authorization for the Department of State to pay for the examination. Candidates who live within 50 miles of Washington, DC must schedule their medical exams at the State Department’s Office of Medical Services. Those who live more than 50 miles from Washington may have them done by their own physician or at the State Department. Children under the age of six must be seen by their own pediatrician, regardless of location.

Regardless of who administers the medical clearance exam, the Department’s Office of Medical Services determines whether or not a candidate is medically eligible for assignment to all Department of State posts worldwide. While a candidate may effectively manage a chronic health condition or limitation within the United States or in specific areas outside of the U.S., the Office of Medical Services might well determine that the same individual is not eligible for a worldwide ("Class One") medical clearance. Such clearances may only be issued to candidates whom the Office of Medical Services deems able to serve at the most isolated and restricted overseas posts.

Such a post could feature extreme isolation in terms of limitations on reliable air service in and out of the country, unreliable Internet and telecommunications connections, and/or unreliable postal and delivery systems. Any of these limited services can have a severe adverse impact in terms of both bringing in required medical services and/or supplies, and/or permitting timely medical evacuations. Other infrastructure at such a post might also be inadequate. There might be a poor or negligible public health system, poor sanitation, unreliable electricity and a lack of potable water. There might also be infectious and communicable diseases, such as malaria, dengue fever, typhoid, tuberculosis, rabies, encephalitis and gastrointestinal diseases. There might be no health unit at the post and next to no local medical facilities. The emergency room, for example, might be completely inadequate, without ventilators, defibrillators, x-ray capabilities, etc. There often would be no blood bank or medical supplies or medications available locally. Because of political instability, security could be a concern.

Candidates should be aware that these posts are not few in number nor confined to a specific geographic region. Also, there are numerous other posts — in Asia and Europe for example — where conditions appear similar to that of the U.S. but which also feature some of these restrictive characteristics.

As a result of these characteristics of a post, the stress level among employees might be very high. Given these concerns, the Department of State would only assign employees with unrestricted medical clearances to such posts (of which there are many), and is unable to hire new employees without such clearances.

While the candidate must be medically cleared for worldwide service, the Department of State does not consider the medical condition of eligible family members for employment purposes. State does, however, require that each eligible family member have a medical clearance before they can travel overseas at U. S. Government expense when accompanying an employee on assignment.

Please note that employees with a family member who has been issued a limited medical clearance (not worldwide) may be assigned to posts where that family member cannot accompany them. We strongly advise candidates to consider this situation as they pursue employment with the Department of State.

On request, the Director General of the Foreign Service, or designee, may consider granting a waiver of the worldwide availability requirement for a candidate who is unable to qualify for a worldwide medical clearance. Candidates should be aware, however, that the granting of such waivers is rare.

For more information on medical clearances, please visit the Frequently Asked Questions page, or visit the Forums.

Security Clearance

Candidates who pass the Oral Assessment must apply for the security clearance required for appointment to the Foreign Service. A comprehensive background investigation, conducted by the U.S. Department of State in cooperation with other federal, state, and local agencies, will provide the information necessary to determine a candidate’s suitability for appointment to the Foreign Service and for a Top Secret security clearance. The process considers such factors as: failure to repay a U.S. Government-guaranteed loan or meet tax obligations; failure to register for the Selective Service; past problems with credit or bankruptcy; unsatisfactory employment records; a criminal record or other violations of the law; drug or alcohol abuse; and less than honorable discharge from the armed forces.

Candidates who hold dual citizenship (pdf), have had extensive travel, education, residence and /or employment overseas, or who have foreign contacts, a foreign-born spouse, immediate family members or relatives who are not citizens of the United States, should be aware that the clearance process will take longer to complete. The background investigation includes interviews with current and previous contacts, supervisors and coworkers. Candidates who do not receive a security clearance are ineligible for appointment. Potential candidates who have any serious issues that may prevent them from receiving a clearance should give some thought to the likelihood of their being found ineligible before starting this process.