36C25618Q0306-005.docx

36C25618Q0306

Attachment 3

SECURITY

BACKGROUND INVESTIGATION INFORMATION

(Submit after award and prior to contract performance)

Complete this form after contract award if contractor employee does not possess a NACI clearance. The completed form must be sent directly to the Contracting Officer within ten days of award.

Vendor Name: ______________________ Cage Code No.______________

Address: _______________________________

City, State, and Zip Code: ______________________________

1. Was the employee prescreened? _____ yes or _____ no

2. Is the employee a U.S. Citizen? _____ yes or _____ no

3. Can the employee read, write, speak and understand English language?

_____ yes or _____no

Information from Employee Requiring a Clearance

Address

City State Zip Code