SOW Appendix 8 - Self Certification of Continuous Service_20200228.pdf
PDF 237 KB Posted
- Solicitation number
- 36C77625B0014
About this file
The document is a Self Certification of Continuous Service form from the Department of Veterans Affairs Personnel Security Adjudication Center. The form allows an individual to certify their break in service from federal employment by selecting one of four options: no break in service, break less than 60 days, break between 60 days and two years (requiring submission of OF 306 form), or break greater than two years or no previous federal employment. The form defines federal employment broadly, including military service (Active, Guard, or Reserve), federal civilian employees, and federal government contractors. It requires the individual to provide their name, social security number, signature, and date, with a section reserved for VA Personnel Security/HR use to document current investigation and risk level.
View the file
Other files
Show all 37
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
DEPARTMENT OF VETERANS AFFAIRS
PERSONNEL SECURITY ADJUDICATION 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 two (2) years. (You are required to submit the OF 306, Declaration for Federal
Employment, with this form.)
My break in service is greater than two (2) years; or I have never had federal employment as defined above.
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 28, 2020
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. Updated .