4_ATT_J-4_Liberty_Security_Guard_Verification_Document.docx

ATTACHMENT J-4

Statue of Liberty Security Guard Verification Document

Employee’s Name: ______________________________________________________

I hereby certify that the above named employee fulfilled all the requirements stated below, and that the following documents are all current, valid, and properly filed in the employee’s personnel file as required by Task Order number _____________________.

Resume / Transcripts / Diploma

Vision & Hearing Certification

Pre-employment Drug Screening

Initial Training Completion (Guards working at screening site)

Initial Supervisory Training Completion, if applicable

Initial Command Center Training Completed, if applicable

Initial Sentry Guard Training Completion, if applicable

Passing Score On Written Examination

State Security Guard License(s)

Signed non-disclosure form

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

Information provided in this certification is subject investigating and verification under Title 18, Section 1001 United State Code. Any false or misleading information may be punishable by fine or imprisonment.

This certification shall be completed and submitted to the COR prior to the employee’s initial performance under the Task Order and every five (5) years thereafter. A copy of this certification shall also be placed in the Task Order employee’s personnel file and shall be updated to reflect certification renewals as they occur.