2-Background Check Form.pdf

PDF 228 KB Posted

Attached to
Campus Fitness Programs State and local contract opportunity
Solicitation number
RFP 26-046KB
Issued by
Fort Bend County, Texas

About this file

Written by GovTribe AI ·

This is a Background Check Form used by Fort Bend Independent School District (FBISD) in Texas for vendor qualification and clearance related to the Campus Fitness Programs contract opportunity. The form is designed to collect project sponsor details, vendor information, and contract worker details to determine background check requirements. The form requires vendors to indicate whether they will have direct contact with students, defined as activities providing substantial opportunity for verbal or physical interaction with students not supervised by certified educators or other district employees. Vendors that are qualified entities under the National Child Protection Act (NCPA) and provide care or placement services for children, the elderly, or individuals with disabilities are exempt from FBISD-conducted background checks.

The form accommodates up to ten contract workers, requiring collection of each worker's first name, middle name, last name, date of birth, driver's license number, and driver's license state abbreviation. Sections include spaces for project sponsor contact information (name, phone, email, department, project start and end dates) and authorized representative details. The form indicates an internal HR clearance section tracking HR review status, clearance dates, and exceptions noted during the review process. Vendors must complete Section 2 and sign the form; if no direct student contact is indicated, the background check requirement may be waived depending on NCPA qualification status.

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Other files for this state and local contract opportunity

Other files attached to Campus Fitness Programs, newest first.
File Type Posted
1-Insurance Requirements.pdf PDF
4-Form 1295 Instructions - How to Complete the Form.pdf PDF
6-Sample DPA - Data Protection Agreement Addendum (v4.1).pdf PDF
11-Form 1295 Acknowledgment for Exemptions Form.pdf PDF
8-Sample FBISD Agreement for Services FBISD (6.2.25).pdf PDF
5-EDGAR Certifications (2 CFR Section 200 REQUIRED PROVISIONS).pdf PDF
3-Suspension and Debarment Certification.pdf PDF
12-RFP 26-046KB Scope of Work.pdf PDF
9-Vendor Acknowledgement Form.pdf PDF
10-CIQ Forms-Updated 9.30.25.pdf PDF
7-General Provisions for Purchasing Solicitations and Contracts (3.3.25).pdf PDF
Show all 11

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Text version

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X X

FOR INTERNAL USE ONLY

HR Clearance:

2.4 HR clear date:

2.5 Number of exceptions noted by HR:

BACKGROUND CHECK FORM

Sec. 1: Project Sponsor Details. To Be Completed after Submissions

(FOR INTERNAL USE ONLY)

Name:

Phone #:

E-Mail:

Department:

Project Start Date:

Project End Date:

Vendor MUST complete Sec. 2. If there will be no direct contact with students, check the "NO" box and sign the form.

Sec. 2: Vendor Details

2.1 Vendor Name:

2.2 Will Vendor have direct contact with students? Yes No

*Contact that results from activities that provide substantial opportunity for verbal or physical interaction with students and that is NOT supervised by a certified educator or other professional district employee.

2.3 Is Vendor NCPA qualified? Yes No

*Under the National Child Protection Act (NCPA) only qualified businesses and organizations that provide care or placement services for the care, treatment, education, training, instruction, supervision or recreation to children, the elderly, or individuals with disabilities can become a qualified entity under NCPA and will not require background check conducted by

FBISD.

Sec. 3: Contract Worker Details

First Name Middle Name Last Name DOB DL# DL State Abb

*Attach additional pages as necessary

Name & Title of Authorized Representative Signature of Authorized Representative

Name:
Phone:
EMail:
Department:
Project Start Date:
Project End Date:
Sec 2 Vendor Details:
22 Will Vendor have direct contactwithstudents:
Contact that results from activities that provide substantial opportunity for verbal or physical interaction with students and:
No:
Under the National Child Protection Act NCPA only qualified businesses and organizations that provide care or placement:
Yes:
Sec 3 Contract Worker DetailsRow1:
First Name1:
Middle Name1:
Last Name1:
DOB1:
DL1:
DL State Abb1:
First Name2:
Middle Name2:
Last Name2:
DOB2:
DL2:
DL State Abb2:
First Name3:
Middle Name3:
Last Name3:
DOB3:
DL3:
DL State Abb3:
First Name4:
Middle Name4:
Last Name4:
DOB4:
DL4:
DL State Abb4:
First Name5:
Middle Name5:
Last Name5:
DOB5:
DL5:
DL State Abb5:
First Name6:
Middle Name6:
Last Name6:
DOB6:
DL6:
DL State Abb6:
First Name7:
Middle Name7:
Last Name7:
DOB7:
DL7:
DL State Abb7:
First Name8:
Middle Name8:
Last Name8:
DOB8:
DL8:
DL State Abb8:
First Name9:
Middle Name9:
Last Name9:
DOB9:
DL9:
DL State Abb9:
First Name10:
Middle Name10:
Last Name10:
DOB10:
DL10:
DL State Abb10:
Text5:

File details come from the government source that posted it. Updated .