ATTACHMENT 5 (UPDATED) - PDS Personal Data Sheet for Contractor.xlsx
XLSX spreadsheet 89 KB Posted
- Attached to
- GARDENING SERVICES FOR U. S. EMBASSY PHILIPPINES
- Solicitation number
- 19RP3824Q0019
- Issued by
-
Department of State
About this file
This document is a Personal Data Sheet for Contractor (PDS) form. The PDS form collects detailed personal and employment information from potential contractors, including contact details, citizenship, education, military service, references, employment history, skills, and any criminal or medical history. The information provided in this form is used by the Department of State to evaluate the qualifications of individuals for work with the Foreign Service.
The second document is a Request for Quotations (RFQ) for Gardening Services for the U.S. Embassy in the Philippines. The RFQ seeks proposals from interested vendors to provide gardening services at the embassy. Key details include a mandatory pre-quotation conference and site visit on April 26, 2024, with quotations due by May 16, 2024. The U.S. Government intends to award a contract or purchase order to the responsible company submitting the lowest acceptable price, without holding discussions. Offerors must be registered in the System for Award Management (SAM) database prior to submitting a proposal.
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Text version
| PERSONAL DATA SHEET | DATE OF APPLICATION |
| (This PDS is for Field use only) | |
| INSTRUCTIONS: The questions on this application should be answered fully and completely. Do not use the abbreviation "NA" to respond to any question; all questions are applicable and should be given an appropriate response. Making a false statement on this form will result in rejection of your application; if discovered sub-sequent to your appointment, a false statement is cause for dismissal and future employment. |
1. NAME IN FULL (Enter regularly used surname with other names used following in Spanish or other double names) ATTACH PHOTOGRAPH TAKEN WITHIN PAST 12 MONTHS
(Last) (First) (Middle)
2. NAME AT BIRTH, IF DIFFERENT FROM ABOVE
| 3. HAVE YOU EVER BEEN KNOWN BY ANY OTHER NAMES? |
| If yes, name and explain circumstances under item 36. |
4. PRESENT ADDRESS & TELEPHONE NUMBER 5. DATE OF BIRTH (MM / DD / YYYY) 7. SEX
6. PLACE OF BIRTH (City, Country)
| 8. HEIGHT | 9. WEIGHT | 10. COLOR OF EYES | 11. COLOR OF HAIR | 13. MARITAL STATUS |
| ___ft ___in | _____lbs. |
12. ANY SPECIAL CHARACTERISTICS OR IDENTIFYING MARKS
| 14. PREVIOUS ADDRESSES DURING PAST TEN YEARS | ||||
| DATES | STREET AND NUMBER | CITY (District/Province) | Country | |
| FROM | TO |
| 15. DO YOU HAVE PERMANENT U.S. RESIDENT STATUS? | ||
| LIST EACH COUNTRY OFWHICH YOU HAVE BEEN A CITIZEN | ||
| DATES | COUNTRY | HOW CITIZENSHIP WAS ACQUIRED |
16a. FULL NAME OF SPOUSE (If wife, maiden name) b. DATE OF BIRTH c. PLACE OF BIRTH
d. PRESENT ADDRESS IN FULL e. PRESENT OCCUPATION
f. CITIZENSHIP AT BIRTH g. PRESENT CITIZENSHIP
| 17. CHILDREN | |||
| NAME | DATE OF BIRTH | PRESENT ADDRESS IN FULL | OCCUPATION |
18. FATHER'S NAME b. DATE OF BIRTH c. PLACE OF BIRTH
d. PRESENT ADDRESS IN FULL e. PRESENT OCCUPATION
f. CITIZENSHIP AT BIRTH g. PRESENT CITIZENSHIP
Yes No
MALE
FEMALE
Single Married Widowed Divorced Separated Remarried
YES
NO
19. MOTHER'S NAME b. DATE OF BIRTH c. PLACE OF BIRTH
d. PRESENT ADDRESS IN FULL e. PRESENT OCCUPATION
f. CITIZENSHIP AT BIRTH g. PRESENT CITIZENSHIP
| 20. RELATIVES (Brothers, sisters and in-laws) | ||||
| NAME | RELATIONSHIP | NATIONALITY | OCCUPATION | PRESENT ADDRESS IN FULL |
21. ARE ANY RELATIVES OR FAMILY MEMBERS NAMED ABOVE EMPLOYED BY AN AGENCY OR REPRESENTATIVE OF A NATIONAL OR LOCAL GOVERNMENT? (If so, list name, relationship, agency and agency address)
22. DO YOU HAVE ANY PERSONAL, BUSINESS OR PROFESSIONAL CONTACTS IN THE UNITED STATES? (If so, list name, business or occupation and address)
23. TRAVEL (If you have ever traveled in any other countries give the dates, duration and purpose of such travel. If travel was in the United States, supply under item 38 additional data, including type of visa, place and date of issuance, date and port of arrival in the United States, places of residence in the United States and the date and port of departure from the United States.)
| COUNTRY | DATES | PURPOSE | |
| FROM | TO |
24. MEMBERSHIPS, SOCIETIES, ASSOCIATIONS, CLUBS AND OTHER ORGANIZATIONS OF WHICH YOU ARE NOW OR HAVE BEEN A MEMBER, EXCEPT RELIGIOUS OR POLITICAL AFFILIATIONS
NAME ADDRESS TYPE FROM / TO OFFICE HELD
25. MILITARY SERVICE (Outline military service past or present, giving country of service, branch of service, unit or organization, specialty, highest rank held, dates of service, present rank, and date and type of discharge)
26. LIST ANY TITLES, ORDERS OR DECORATIONS BESTOWED UPON YOU TITLES, ORDERS OR DECORATIONS DATE BESTOWED
YES
NO
YES
NO
| 27. EDUCATION | ||||
| NAMES AND LOCATIONS OF EDUCATIONAL INSTITUTIONS ATTENDED | DATES | DEGREES | MAJOR SUBJECTS | |
| FROM | TO |
| 28. LANGUAGES (Name and indicate the extent of your competence) | ||||||||||||
| LANGUAGE / DIALECT | SPEAK | READ | WRITE | UNDERSTAND | ||||||||
| Excellent | Good | Fair | Excellent | Good | Fair | Excellent | Good | Fair | Excellent | Good | Fair |
29. REFERENCES, LIST THREE COMPETENT AND RESPONSIBLE PERSONS NOT RELATED TO YOU BY BLOOD OR MARRIAGE, WHO ARE QUALIFIED TO SUPPLY DEFINITE INFORMATION REGARDING YOUR CHARACTER AND ABILITY (Do not give names of supervisors listed in item 30)
NAME ADDRESS IN FULL CONTACT NO. / EMAIL OCCUPATION
30. EMPLOYMENT. (In the space provided below describe every position which you have held since you first began to work. Start with Present Position and work back to the first position which you held. Account for all periods of unemployment and State reasons for any unemployment indicated. If not enough space use Continuation Sheet)
| IF CURRENTLY EMPLOYED MAY WE APPROACH YOUR PRESENT EMPLOYER? | |||
| A. DATES OF EMPLOYMENT (Month, Year) | EXACT TITLE OF YOUR POSITION | SALARY OR EARNINGS | |
| Starting | per year | ||
| Final | per year | ||
| NAME & FULL ADDRESS OF EMPLOYER | DUTIES |
NAME & TITLE OF IMMEDIATE SUPERVISOR
REASON FOR WANTING TO LEAVE
| B. DATES OF EMPLOYMENT (Month, Year) | EXACT TITLE OF YOUR POSITION | SALARY OR EARNINGS | |
| Starting | per year | ||
| Final | per year | ||
| NAME & FULL ADDRESS OF EMPLOYER | DUTIES |
NAME & TITLE OF IMMEDIATE SUPERVISOR
REASON FOR WANTING TO LEAVE
| C. DATES OF EMPLOYMENT (Month, Year) | EXACT TITLE OF YOUR POSITION | SALARY OR EARNINGS | |
| Starting | per year | ||
| Final | per year | ||
| NAME & FULL ADDRESS OF EMPLOYER | DUTIES |
NAME & TITLE OF IMMEDIATE SUPERVISOR
REASON FOR WANTING TO LEAVE
YES
NO
31. SPECIAL QUALIFICATIONS AND SKILLS. (List any special skills you possess and machines and equipment you can use, such as Multilith, Comptometer, Key pouch etc.) Approximate Number of Words per minute
| Typing | |||
| Shorthand | |||
| ANSWER ITEMS 32 THROUGH 35 BY PLACING AN "X" IN THE PROPER COLUMN | YES | NO | |
| 32. HAVE YOU EVER BEEN DISCHARGED OR FORCED TO RESIGN FOR MISCONDUCT OR UNSATISFACTORY SERVICE FROM A POSITION? (If answer is "YES" give detail under item 38) |
| 33. a. HAVE YOU NOW OR HAVE YOU EVER HAD ANY PHYSICAL LIMITATIONS? | ||
| b. ARE YOU NOW UNDER A PHYSICIANS CARE AND IF SO, FOR WHAT REASON? . | ||
| c. HAVE YOU EVER HAD A NERVOUS DISORDER? | ||
| d. HAVE YOU EVER HAD TUBERCULOSIS? | ||
| e. WITHIN THE PAST 12 MONTHS, HAVE YOU USED INTOXICATING BEVERAGES TO EXCESS | ||
| f. DO YOU HAVE A DRUG OR NARCOTIC ADDICTION? | ||
| g. WERE YOU EVER MEDICALLY DISCHARGED FROM THE ARMED FORCES? | ||
| IF ANY OF YOUR ANSWERS TO ANY OF THE ABOVE IS "YES" GIVE PARTICULARS UNDER ITEM 38 | ||
| 34. HAVE YOU EVER BEEN ARRESTED OR DETAINED BY ANY POLICE OR MILITARY AUTHORITY (If so, name the Authority, give time, place, reason and the disposition of court action) | YES | NO |
35. ARE YOU NOW, OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY OR ANY COMMUNIST OR FASCIST OR TERRORIST ORGANIZATIONS?
36. ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP, OR COMBINATION OF PERSONS WHICH ADVOCATES THE OVERTHROW OF THE CONSTITUTIONAL FORM OF GOVERNMENT OF THE UNITED STATES, OR ANY ORGANIZATION ASSOCIATION, MOVEMENT, GROUP OR COMBINATION OF PERSONS WHICH HAS ADOPTED A POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OR FORCE OR VIOLENCE TO DENY OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES OR OF SEEKING TO ALTER THE FOR OF GOVERNMENT OF THE UNITED STATES BY UNCONSTITUTIONAL MEANS?
37. IF YOU ANSWER TO ITEMS 35 OR 36 IS "YES" STATE THE NAME OF THE ORGANIZATION, DATES OF MEMBER SHIP OR ASSOCIATION, AND EXTENT OF YOUR PARTICIPATION. IF YOU DESIRE TO EXPLAIN THE CIRCUMSTANCES OF YOUR MEMBERSHIP, USE SPACE UNDER ITEM 38 OR ATTACH A SEPARATE PAGE
NAME ADDRESS TYPE FROM TO OFFICE HELD
38. USE THIS SPACE FOR DETAILED ANSWERS. NUMBER ANSWERS TO CORRESPOND WITH QUESTIONS. ADD ANY INFORMATION NOT COVERED ABOVE WHICH MIGHT AFFECT YOUR EMPLOYMENT, USE EXTRA BLANK PAGES, IF NECESSARY
| PRIVACY ACT STATEMENT |
| (APPLICABLE ONLY TO APPLICANTS WHO ARE RESIDENT ALIENS OF THE U.S.) |
| The Foreign Service Act of 1980, as amended, implies the authority to solicit personal information from individuals due to its relevance to the appointment, training, evaluation and assignment processes. This information is used by the Department of State to assist in evaluating your qualifications work with the Foreign Service. The information you furnish will be reviewed by authorized persons within the Department of State and other agencies at posts abroad as requested. Failure to answer all applicable questions on this form may delay consideration of your application and could result in your not receiving full consideration for a position in which this information is needed. |
| CERTIFICATION |
| BEFORE SIGNING THIS FORM MAKE SURE YOU HAVE ANSWERED ALL QUESTIONS FULLY ANC COMPLETELY. A FALSE STATEMENT ON THIS APPLICATION IS CAUSE FOR DISMISSAL AND IT COULD PREVENT FUTURE EMPLOYMENT. |
I DO SOLEMNLY AFFIRM THAT THE INFORMATION CONTAINED HEREIN IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
(Name as usually written and which will be used as official signature) Date
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