36C24918R0178-005.pdf
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- Attached to
- Mobile Lithotripsy Federal contract opportunity
- Solicitation number
- 36C24918R0178
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36C24918R0178 Attachment 3b Self Certification of Continuous Service 02-16-2017.pdf
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24918R0178-000.docx | DOCX document | |
| 36C24918R0178-008.docx | DOCX document | |
| 36C24918R0178-006.docx | DOCX document | |
| 36C24918R0178-002.docx | DOCX document | |
| 36C24918R0178-009.docx | DOCX document | |
| 36C24918R0178-007.docx | DOCX document | |
| 36C24918R0178-003.pdf | ||
| 36C24918R0178-004.pdf | ||
| 36C24918R0178-001.rtf | RTF text file |
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Text version
DEPARTMENT OF VETERANS AFFAIRS
SECURITY AND INVESTIGATIONS CENTER
Self Certification of Continuous Service
I hereby certify my break in service from my last federal employment is indicated by the block checked below.
I have NOT had a break in service.
My break in service was less than 60 days.
My break in service was greater than 60 days, but less than 2 years. (You are required to submit the OF 306, Declaration for
Federal Employment, with this form.)
My break in service is greater than 2 years or; I have never had employment through the federal government.
Print Name: Social Security Number:
Signature: Date:
VA Personnel Security/HR Use Only:
Current Investigation in PIPS: Date:
Risk level of current position: Verified by:
(Check One)
Federal employment is defined as any branch of the United States military (Active, Guard or Reserve), federal government civilian employee (any federal government agency), or a contractor working for the federal government.
Self Certification of Continuous Service Form Revised February 14, 2017
Previous Versions are Obsolete
| I have NOT had a break in service: Off |
| My break in service was less than 60 days: Off |
| My break in service was greater than 60 days but less than 2: Off |
| My break in service is greater than 2 years or I have never worked: Off |
| Print Name: |
| Social Security Number: |
| Date: |
| Current Investigation in PIPS: |
| Date_2: |
| Risk level of current position: |
| Verified by: |
File details come from the government source that posted it.