4. SioanForm380-2 Personal Data Questionnaire.pdf
PDF 146 KB Posted
- Attached to
- Vertical Turning Center (VTC Federal contract opportunity
- Solicitation number
- W911KF-21-Q-0069
About this file
This document contains a personal data questionnaire and details regarding a federal contract opportunity for a vertical turning center. The personal data questionnaire requests information such as the individual's name, Social Security number, date and place of birth, physical description, driver's license and address history for security screening purposes at Anniston Army Depot. The federal contract opportunity is solicited by the Department of the Army Materiel Command Contracting Command Detroit Arsenal for a new heavy-duty vertical turning center. Requirements include box ways, precision spindle bearings, flood coolant system, through tool coolant, work light, splash guard enclosure, spare parts, manuals, standard tools, and accessibility for wear parts replacement and repair. The machine must utilize ISO programming format and accept programs from off-line systems.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| W911KF-21-Q-0069 0002 Layout.pdf | ||
| 9. LAYOUT - CNC Vertical Turning Center.pdf | ||
| W911KF-21-Q-0069 0001.pdf | ||
| 1. Statement of Work.pdf | ||
| 2. Evidence of Authority To Sign Offers.pdf | ||
| 6. DD Form 1423 Contract Data Requirement List.pdf | ||
| 7. DD Form 1664 Data Item Description.pdf | ||
| 8. ACC-ANAD COVID Letter.pdf | ||
| W911KF-21-Q-0069 - Solicitation.pdf | ||
| 3. Request for Technical Literature.pdf | ||
| 5. Past Performance Questionnaire.pdf |
Show all 11
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Text version
Request Recurring: Yes / No PERSONAL DATA QUESTIONNAIRE – (See AR 380-67 for use of this form; proponent is AMSTA-AN-ESP)
CONTRACTOR COMPANY NAME (Prime)
WORK PHONE
SUBCONTRACTOR NAME
CONTRACT NUMBER
CONTRACT EXPIRES
INDIVIDUAL’S NAME (First name, Middle name, Last name) ***NO INITIALS ***
SSN
OTHER NAMES USED (INCLUDE FORMER MARRIED NAMES)
TYPE BADGE/AREA:
DATE OF BIRTH PLACE OF BIRTH CITIZENSHIP
MONTH
DAY
YEAR
CITY
COUNTY
STATE
*** NOTE ***IF YOU WERE BORN OUTSIDE OF THE UNITED STATES, YOU MUST FURNISH PROOF OF U.S.
CITIZENSHIP UPON SUBMISSION OF THIS FORM TO THIS INSTALLATION. PROOF OF U.S. CITIZENSHIP MUST BE SUBMITTED IN PERSON BY THE INDIVIDUAL, ALONG WITH THIS FORM, TO THE BADGE OFFICE, PHYSICAL SECURITY DIVISION, DES.
PHYSICAL DESCRIPTION COLOR EYES
COLOR HAIR
HEIGHT
WEIGHT
SEX
RACE
DRIVERS LICENSE NO.
STATE OF ISSUE
OR STATE IDENTIFICATION NO.
STATE OF ISSUE
ADDRESSES FOR THE PAST FIVE (5) YEARS, INCLUDING PRESENT ADDRESS: (STREET, CITY, COUNTY, STATE)
1. 4.
(County) (County)
2. 5.
(County) (County)
3. 6.
(County) (County) AUTHORITY: Internal Security Act of 1950 (50 USC 797); Executive Order 9397. PRINCIPAL PURPOSE: To document information necessary for selection, assignment or termination for persons desiring entry to all, or parts, of Anniston Army Depot.
ROUTINE USES: The information provided will be furnished to the Directorate of Emergency Services at Anniston Army Depot; to officials within the Department of Defense who have a need for it to perform official business. NATURE OF DISCLOSURE:
Disclosure of the requested information is voluntary. Failure to provide the information, however, may result in being denied unescorted access to the installation.
LEGAL SIGNATURE OF INDIVIDUAL REQUESTING ACCESS:
DATE
********************** CERTIFICATION **********************
I certify that the individual named above is, in fact, an employee of the company as listed above. I understand that a knowing and willful false statement can be punished by fine or imprisonment, or both. (U.S. Code, title 18 USC 1001)
SIGNATURE OF AUTHORIZED PERSONNEL/REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
DISAPPROVED SIGNATURE OF DISAPPROVING OFFICIAL
APPROVED
____ PHOTOGRAPHIC BADGE
____ NON-PHOTOGRAPHIC BADGE – NO ESCORT REQUIRED
____ NON-PHOTOGRAPHIC BADGE - ESCORT REQUIRED
NO DRIVING PRIVILEGES
Badge Office Issues Letter
SIGNATURE OF APPROVING OFFICIAL: DATE
SIOAN Form 380-2, Rev 11 Mar 08 PREVIOUS EDITIONS OBSOLETE
| SSN |
| TYPE BADGE/AREA: |
| CITIZENSHIP |
| PLACE OF BIRTH |
| DATE OF BIRTH |
| STATE |
| COUNTY |
| CITY |
| YEAR |
| DAY |
| MONTH |
| *** NOTE ***IF YOU WERE BORN OUTSIDE OF THE UNITED STATES, YOU MUST FURNISH PROOF OF U.S. CITIZENSHIP UPON SUBMISSION OF THIS FORM TO THIS INSTALLATION. PROOF OF U.S. CITIZENSHIP MUST BE SUBMITTED IN PERSON BY THE INDIVIDUAL, ALONG WITH THIS FORM, TO THE BADGE OFFICE, PHYSICAL SECURITY DIVISION, DES. |
| HEIGHT |
| WEIGHT |
| SEX |
| RACE |
| PHYSICAL DESCRIPTION |
| COLOR EYES |
| COLOR HAIR |
| OR |
| STATE OF ISSUE |
| STATE IDENTIFICATION NO. |
| STATE OF ISSUE |
| DRIVERS LICENSE NO. |
| ADDRESSES FOR THE PAST FIVE (5) YEARS, INCLUDING PRESENT ADDRESS: (STREET, CITY, COUNTY, STATE) |
| 4. |
| 1. |
| (County) |
| 5. |
| (County) |
| 6. |
| (County) |
| AUTHORITY: Internal Security Act of 1950 (50 USC 797); Executive Order 9397. PRINCIPAL PURPOSE: To document information necessary for selection, assignment or termination for persons desiring entry to all, or parts, of Anniston Army Depot. ROUTINE USES: The information provided will be furnished to the Directorate of Emergency Services at Anniston Army Depot; to officials within the Department of Defense who have a need for it to perform official business. NATURE OF DISCLOSURE: Disclosure of the requested information is voluntary. Failure to provide the information, however, may result in being denied unescorted access to the installation. |
| DATE |
| LEGAL SIGNATURE OF INDIVIDUAL REQUESTING ACCESS: |
| ********************** CERTIFICATION ********************** |
| DATE |
| SIGNATURE OF AUTHORIZED PERSONNEL/REPRESENTATIVE |
| DO NOT WRITE BELOW THIS LINE |
| DISAPPROVED |
| DATE |
| SIGNATURE OF DISAPPROVING OFFICIAL |
| NO DRIVING PRIVILEGES |
| APPROVED |
| DATE |
| SIGNATURE OF APPROVING OFFICIAL: |
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