Exhibit 9 - OVQ Form.pdf
PDF 4 MB Posted
- Attached to
- Make-Ready Services Rome, Italy Federal contract opportunity
- Solicitation number
- 191T7022R0001
- Issued by
- Department of State
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Questions and Answers Additional.doc | DOC document | |
| Conference Minutes.pdf | ||
| Minutes.pdf | ||
| Conference Questions and Answers.doc | DOC document | |
| Cover Letter.pdf | ||
| 191T7022R0001.doc | DOC document | |
| SF-1442.doc | DOC document | |
| Exhibit 3 - MakeReady Services Checklists.docx | DOCX document |
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OVERSEAS VETTING QUESTIONNAIRE (OVQ)
PERSONS COMPLETING THIS FORM SHOULD BEGIN AFTER CAREFULLY READING THE PRECEDING INSTRUCTIONS.
I have read the instructions and I understand that if I withhold, misrepresent, or falsify information on this form, I am subject to the penalties for inaccurate or false statement (per U.S. Criminal Code, Title 18, section 1001), or removal and debarment from Federal or contract employment.
SECTION 1 – Personal Information Date of Birth Sex Place of Birth Have you ever used another birth date in legal documentation?
Former Names/Aliases Have you been known by any other names?
Complete the following if you have responded 'Yes' to having used other names:Enter your Surname, Given Name, and Middle Name in the spaces provided. If you only have initials in your name, provide them under the "Surname" and indicate "(Initials only)". When entering a date (MM/YYYY) provide the exact date if known or if your do not recall the exact date enter your best estimate of what you believe the exact date to be and mark the "Est" box next to that entry. Indicate if the name entered was your Maiden (pre-marriage) name and provide the reason you changed your name.
Alias Information (Click the button to add or remove alias fields) Dates name used (MM/YYYY) Provide the reason for the name change. If not a maiden name, use the box below for your reason Was this your maiden name?
Citizenship & Identification Citizenship (Click to the right to add/remove countries of citizenship) Provide the name of the country and the period of time you held citizenship with this country Proof of Citizenship The name the citizenship was issued under Forms of Identification (Provide as many as possible by clicking '+' to the right) Physical Description Hair Eye Height (meters or feet/inches) Weight (kilograms or pounds) Describe any unique features or identifying marks on your body. (Example: I have star shaped scars on my left shoulder and chin.)
Contact Information Please provide your current contact information SECTION 2 – Residency History List the places where you have lived beginning with your current residence and working back seven years. Residences for the entire period must be accounted for without breaks. Indicate the actual physical location of your residence, not a Post Office box or a permanent residence where you were not physically located. If you split your time between one or more residences during a time period, you must list all residences. Do not list residence before your 18th birthday unless you are doing this to provide a minimum of two years residence history.
You are not required to list temporary locations of less than 90 days that did not serve as your permanent or mailing address.
For your current address provide a person who knows you at that address, and who preferably still lives in that area. Do not list people who knew you well for residences completely outside this period, and do not list your spouse, cohabitant or other relatives.
Have you lived in the United States for more than six (6) months continuously during the past seven (7) years?
2.A - Current Residence Provide the dates in which you lived in this residence. If you do not recall the exact date enter your best estimate and mark the "Est" box Residency Status:
Landlord's Contact Information Neighbor's Contact Information 2.B - Prior Residences Provide the dates in which you lived in this residence. If you do not recall the exact date enter your best estimate and mark the "Est" box Residency Status:
Landlord's Contact Information SECTION 3 - Education History Have you received a Degree, Diploma, or Certification in the last seven years?
Recent Schooling (Click to the right to add/remove schools) Have you received a Degree, Diploma, or Certification more than seven years ago?
Previous Schooling (Click to the right to add/remove schools) SECTION 4 - Employment History (If you have never held a job/work position before, proceed immediately to the next section. If this is not the case please list all of your employment activities, including unemployment and self-employment, beginning with the present and working back seven years. The entire period must be accounted for without breaks. If the employment activity was military duty, list separate employment activity periods to show each change of military duty station. Provide separate entries for employment activities with the same employer but having different physical addresses. Do not list employment before your 18th birthday unless to provide a minimum of 2 years employment history.)
Employment (All employment in the last 7 years) Select the type of employment (employed, unemployed, military) and enter the time period related to it (If you do not recall the exact date enter your best estimate and mark the "Est" box). You must account for the last 7 years with no interruptions Provide the organization's address and a supervisor's contact information (if unemployed, provide contact info for someone who can verify).
4.B - Additional Employment Information Have you served in the US Military Service more than 7 years ago?
Military Service Description If you have no military discharge date, leave the field blank Military Duty Assignments Provide the time frame you were assigned to this unit/organization. (If you don't recall an exact date enter your best estimate and mark the "Est" box) Have you worked for a non-US government organization more than seven (7) years ago?
General Foreign Military Service Description If you have no military discharge date, leave the field blank Foreign Government Information Provide the time frame you were assigned to this unit/organization. (If you don't recall an exact date enter your best estimate and mark the "Est" box) SECTION 5 - Social References Provide contact information for three (3) persons who are not family relations and are not listed in other sections of this form Social Reference 1 (Provide contact information for a person who knew you during the past seven (7) years.)
How long have you known this person?
Social Reference 2 (Provide contact information for a person who knew you during the past seven (7) years.)
How long have you known this person?
Social Reference 3 (Provide contact information for a person who knew you during the past seven (7) years.)
How long have you known this person?
Section 6 - Marital Status/Domestic Union Status/Domestic Partnership Status Provide your current status (check all that apply) Current Partners/Spouses Start of relationship Partner's Sex Provide your Spouse/Domestic Partner's address if different than yours.
Former Partners/Spouses How long did this relationship last?
Partner's Sex Provide your Former Spouse/Domestic Partner's address if different than yours.
SECTION 7 – Relationships
7.1 - Parents Father (Click to the right to add/remove fathers) Father's Information Mother (Click to the right to add/remove mothers) Mother's Information
7.2 - Siblings Siblings (Click to the right to add/remove siblings) Sibling's Information Relationship to you (check all that apply)
7.3 - Children Children (Click to the right to add/remove children) Child's Information SECTION 8 - Foreign Travel Have you traveled outside the country in the past seven (7) years?
Provide the following details and click "+" to record more travel (If you don't recall the exact date enter your best estimate and mark the "Est" box) Foreign Trip Details SECTION 9 - Prior Investigations Has the United States Government (or any foreign government) EVER investigated you?
Did the investigation result in your clearance being denied/revoked?
SECTION 10 - General Questions 10A - Financial 10A.1 - Have you experienced difficulty paying your bills during the past seven (7) years?
10A.2 - Has the financial difficulty mentioned in the previous question been resolved?
10A.4 - Have you formally declared bankruptcy (an inability to pay your debts) during the past seven (7) years?
10A.5 - Have you, your spouse, cohabitant, or dependent children EVER had financial interests (such as stocks, property, investments, bank accounts, ownership of corporate entities, corporate interests or businesses) in a country other than that of your citizenship?
10B - Legal 10B.1 - In the past (7) years, have you been issued a summons, citation, or ticket to appear in court in a criminal proceeding against you?
10B.2 - In the past (7) years, have you been charged, convicted, or sentenced with a crime in any court?
10B.3 - In the past (7) years, have you been a party to any public record civil court action not listed elsewhere on this form?
10B.4 - Have you been debarred from government employment?
10B.5 - Have you been arrested, detained, or questioned by police in the past seven (7) years?
10B.6 - Have you illegally or without proper authorization accessed or attempted to access any information technology system?
10B.7 - Have you ever used any drugs or controlled substances? (Use of a drug or controlled substance includes injecting,snorting, inhaling, swallowing, experimenting with or otherwise consuming any drug or controlled substance) 10B.8 - Have you ever used any drugs or controlled substances without a doctor's prescription?
10B.9 - Have you ever been involved in trafficking substances such as weapons, persons, drugs, controlled substances, etc.?
10C - Associations & Conduct 10C.1 - Do you, your associates, or family have connections to any persons, groups, governments, or countries that create a conflict of interest?
10C.2 - Have you been involved in any act of sabotage, espionage, treason, terrorism or other acts to overthrow a government?
10C.3 - Have you associated or sympathized with persons involved in sabotage, espionage, treason, terrorism or similar acts?
10C.4 - Have you engaged in conduct which may make you vulnerable to coercion, exploitation, or blackmail?
10C.5 - Have you concealed information which may make you vulnerable to coercion, exploitation, or blackmail?
10D - Additional Disclosures Certification My statements on this form, and on any attachments to it, are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I have carefully read the foregoing instructions to complete this form. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (18 U.S.C. 1001). I understand that intentionally withholding, misrepresenting, or falsifying information may have a negative effect on my security certification, employment prospects, or job status, up to and including denial or revocation of my security certification, or my removal and debarment from Federal service.
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