CRIME CONTROL ACT.doc

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Speech Language Pathologist Federal contract opportunity
Solicitation number
11-242-SOL-00006
Issued by
Department of Health and Human Services Indian Health Service

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Crime Control Act Questionnaire

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CRIME CONTROL ACT-PL 101-647

Name:

Social Security Number:

xxx-xx

(Please Print)

Job Title in Announcement:

N/A Announcement Number:

N/A

Contract Services: Speech Language Pathology Services

Solicitation/Contract Award Number: 11-242-SOL-00006

Section 231 of the Crime Control Act 1990, Public Law 101-647, requires that employment applications for Federal Child Care positions contain questions asking whether the individual has been arrested for/or charged with a crime involving a child and for the disposition of the arrest or charge.

Section 408 of the Miscellaneous Indian Legislation, Public Law 101-630, contains a related requirement for positions in the Department of Health and Human Services that involve regular contact with or control over Indian Children. The agency must ensure that persons hired for these positions have not been found guilty of or pleaded nolo contend ere (no contest) to violent crimes.

To assure compliance with the above laws, the following questions are added to the Declaration for Federal Employment.

1) Have you ever been arrested for or charged with a crime

Involving a child? (If “Yes”, provide the date, explanation of

Violation disposition of the arrest or charge, place of occurrence, and the name and address of the police department or court involved).

Yes No

2) Have you ever been found guilty of, or entered a plea of nolo contend ere or guilty to, any offense under Federal, State, or Tribal Law involving crimes of violence, sexual assult, molestation, exploitation, contact or prostitution;

or crimes against person(s) (If “Yes”, provide the date, explanation of the violation, disposition of the arrest or charge, place of occurrence, and the name and address of the police department or court involved.

Yes No

I certify that (1) my response to these questions are made under penalty of perjury which is punishable by fines of up to $2000 or five (5) years imprisonment, or both; and (2) I have received notice that a criminal check will be conducted. I understand my right to obtain a copy of any criminal history report made available to the Indian Health Service and my right to challenge the accuracy and completeness of any information contained in the report.

Applicant’s (Offeror’s) Signature

Date

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