2-Background Check Form.pdf

PDF 228 KB Posted

Attached to
Fencing Installation Repair & Services
Solicitation number
RFP 26-064AR
Issued by
Fort Bend County, Texas

About this file

This is a Background Check Form used by Fort Bend Independent School District (FBISD) in Texas to manage vendor compliance and security clearance procedures for contract workers. The form is divided into three sections: Section 1 captures project sponsor details including name, contact information, department, and project timeline; Section 2 requires vendors to declare whether they will have direct contact with students and whether they are National Child Protection Act (NCPA) qualified, as NCPA-qualified entities are exempt from FBI background checks; and Section 3 collects detailed information on up to ten contract workers, including first name, middle name, last name, date of birth, driver's license number, and driver's license state. The form notes that vendors without direct student contact may check "No" and sign the form without further background check requirements. An authorized representative must sign the form, and additional pages may be attached as necessary to accommodate additional contract workers.

The form is designated "For Internal Use Only" and includes fields for HR clearance status, clearance date, and notation of exceptions identified during the review process. No specific pricing terms, contract amounts, or funding sources are addressed in this background check document, as it serves solely as a compliance and security screening tool prior to contract execution. The background check requirement applies to all vendors engaging in activities that provide substantial opportunity for verbal or physical interaction with students that is not supervised by certified educators or other professional district employees.

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Text version

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:

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