#1. REQUEST FOR CRIMINAL HISTORY 05-370.pdf
PDF 168 KB Posted
- Attached to
- WATER SOFTENER SYSTEM
- Solicitation number
- PR2425842
- Issued by
- Adams County, Asotin County, Benton County, Chelan County, Clallam County, Clark County, Columbia County, Cowlitz County, Douglas County, Ferry County, Franklin County, Garfield County, Grant County, Grays Harbor County, Island County, Jefferson County, King County, Kitsap County, Kittitas County, Klickitat County, Lewis County, Lincoln County, Mason County, Okanogan County, Pacific County, Pend Oreille County, Pierce County, San Juan County, Skagit County, Skamania County, Snohomish County, Spokane County, Stevens County, Thurston County, Wahkiakum County, Walla Walla County, Whatcom County, Whitman County, Yakima County, Asotin City, Clarkston City, Clarkston Heights-Vineland CDP, West Clarkston-Highland CDP, Benton City, Chelan City, Chelan Falls CDP, Clallam Bay CDP, Lewisville CDP, Rock Island City, Pacific Beach CDP, Whidbey Island Station CDP, Mercer Island City, Pacific City, Bainbridge Island City, Kingston CDP, Kitsap Lake CDP, Kittitas City, Klickitat CDP, Okanogan City, Anderson Island CDP, Fort Lewis CDP, Fox Island CDP, Herron Island CDP, Ketron Island CDP, North Fort Lewis CDP, Raft Island CDP, Stevenson City, Hat Island CDP, Lake Stevens City, Snohomish City, Spokane City, Spokane Valley City, Puget Island CDP, Garfield Town, Yakima City, Washington
About this file
This document is a Request for Criminal History Record Information form from the Washington State Department of Corrections. It is used to request criminal history checks for various types of individuals, including prospective employees, contract workers, volunteers, visitors, and individuals being considered for parole or furlough. The form requires the submitter to provide personal information such as name, date of birth, sex, race, and driver's license details. The form is used to confirm the individual has a clear criminal history and is eligible for the requested purpose.
The document is related to a state and local contract opportunity for a water softener system at the Coyote Ridge Correctional Center in Connell, Washington. The contract is open to bidders in various counties within the state of Washington. A mandatory site visit/walk-through is scheduled for October 4, 2024. The contract term and pricing details are not provided.
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Text version
DOC 05-370 (Rev. 03/04/22) E-form Page 1 of 1 DOC 390.590, DOC 400.320, DOC 450.310, Scan Code VS11 Scan & Toss DOC 530.100, DOC 590.320, DOC 810.015
REQUEST FOR CRIMINAL HISTORY RECORD INFORMATION
WASIS/NCIC III CHECK NCIC/WACIC CHECK
Routine Urgent Date:
Type of request:
Classification update Visitor re: incarcerated individual Volunteer Intake Contract employee PSI Furlough sponsor Prospective employee ESR/Risk Update Field file Firearms requalification OOS investigation Update Central file Vendor/maintenance worker Release/ORP/parole investigation Wants and Warrants Other:
REQUIRED DATA
Legal name (Last, First, Middle) Date of birth DOC number
Sex at birth Race SID number FBI number
OTHER DATA
Maiden name/alias Birthplace
Maiden name/alias Citizenship
Maiden name/alias Hair Eyes
SSN Height Weight
Current Washington State Driver license Yes No License number:
If driver’s license is issued from another state, list which state:
Mail stop:
Address of submitting office (if no mail stop)
INTAKE/FOS - CASE MANAGER SUBMIT FINGERPRINT CARDS TO YOUR LOCAL RECORDS OFFICE
REQUESTER
Name Signature
Title Date
Date Initials
Employment and Visitor requests only:
Clear Criminal History (NCIC/WACIC) Yes No Clear Criminal History (JABS) Yes No Clear Wants and Warrants Yes No Clear Statewide Visit System Yes No
The contents of this document may be eligible for public disclosure. Social Security Numbers are considered confidential information and will be redacted in the event of such a request. This form is governed by Executive Order 16-01, RCW 42.56, and RCW 40.14.
Distribution: ORIGINAL - Imaging file COPY - As applicable
Perspective bidder / Site Visit
File details come from the government source that posted it. Updated .