S02 D.2.3 WMC Fingerprint Request Form 2.pdf
PDF 437 KB Posted
- Attached to
- 36C25725Q0072 Virtual Pharmacy Service
- Solicitation number
- 36C25725Q0072_2
About this file
This is a Department of Veterans Affairs (VA) fingerprinting request form package consisting of Form #2 and Form #2A for contractors and employees requiring fingerprinting services at VA facilities. The form package is specifically for the WMC HROO Personnel Security Contractor Team using PIV Legacy Systems (SON: 955C / SOI: VA08 IPAC/OPAC: 3600.1200).
The forms require collection of the individual's full legal name, last four digits of SSN, contractor/federal/other status, VA facility information including VAMC name and location, PIV Office Official details, and fingerprinting date. Form 2A provides detailed instructions for completing each field and specifies whether fingerprints are submitted electronically or manually with ink and fingerprint card. The form must be taken to the fingerprinting appointment and emphasizes verification that the full name matches the ID. This appears to be a standard administrative form template revised in May 2023 for processing contractor and employee fingerprinting requests within the VA system.
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| S02 D.2 Background Investigation.docx | DOCX document | |
| S02 D.2.2 Contractor Request Form – Foreign National.pdf | ||
| S02 D.3 Experience Worksheet 36C25725Q0072.docx | DOCX document | |
| S02 RFQ 36C25725Q0072_1 Final.pdf | ||
| S02 D.2.5 Self Certification of Continuous Service Form.pdf | ||
| S02 D.2.4 OF306 Declaration for Federal Employment.pdf | ||
| S02 D.5 Contractor Certification Immigration and Nationality Act.docx | DOCX document | |
| S02 D.6 Organizational Conflicts of Interest.docx | DOCX document | |
| S02 D.4 Contractor Rules of Behavior.docx | DOCX document | |
| S02 D.2.1 WMC Contractor Request US Citizens Only.pdf | ||
| S02 D.1 QASP PLAN After Hours Pharmacy.docx | DOCX document | |
| 36C25725Q0072_2.docx | DOCX document |
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Text version
Revised Form May 2023
** This form must be taken to the fingerprinting appointment **
CONTRACTOR/EMPLOYEE INFORMATION (PLEASE PRINT)
A Full Legal Name (First Middle Last):
B SSN Last Four:
C Contractor/Federal/Other:
NOTE: PLEASE ENSURE FULL NAME IS CORRECT AND CONFIRMED ON ID
VA FACILITY INFORMATION
D VAMC Name & Location:
E PIV Office Official :
F Date Fingerprinted:
(NEW>>> USAccess System Drop-down I.D Below)
WMC HROO PERSEC CONTRACTOR (VA08, 955C, 36001200)
Department of Veterans Affairs WMC HROO Personnel Security Contractor Team
CONTRACTOR/EMPLOYEE FINGERPRINTING REQUEST FORM #2
(PIV Legacy Systems - SON: 955C / SOI: VA08 IPAC/OPAC: 3600.1200)
VHACLEPanosA Highlight
Department of Veterans Affairs VHA 106A WMC HROO PerSecContractor Team
CONTRACTOR / EMPLOYEE FINGERPRINT REQUEST INSTRUCTIONAL FORM 2A
Purpose: The Contractor/Employee Fingerprint Request is to assist individuals in obtaining fingerprinting services from VA Facilities nationwide, on behalf of the WMC.
A Full Legal Name: Please provide full legal name of individual requiring fingerprints.
B SSN Last Four: Please provide the last four of the individual’s social security number.
C Contractor (Yes/No): Please indicate whether the individual is a contractor. Contracted employees are considered contractors.
D VAMC Location: Please provide the name and location of the VA Facility where the fingerprints were submitted.
E Station Number: Please provide the station number of the VA Facility where the fingerprints were submitted.
F Date Fingerprinted: Please provide the date that the fingerprints were submitted at the VA Facility.
G Method of Fingerprinting: Please indicate whether the fingerprints were submitted electronically or if manual fingerprints were submitted with ink and fingerprint card.
H Date Card Mail to OPM: If fingerprints were submitted manually, please provide the date the card was mailed to
NOTE: PLEASE ENSURE FULL NAME IS CORRECT AND CONFIRMED ON ID
| f2a: |
| f2b: |
| f2c: |
| f2d: |
| f2e: |
| f2f: |
File details come from the government source that posted it. Updated .