43ADG-S3865 NVARNG Personal Security Questionnaire.docx
DOCX document 18 KB Posted
- Attached to
- Statewide Fire - Alarm Security Services
- Solicitation number
- 43ADG-S3865
- Issued by
- Nevada
About this file
This is a Personal Security Questionnaire document associated with a statewide fire and alarm security services solicitation issued by the State of Nevada Purchasing Division on behalf of the Nevada Office of the Military, Nevada Department of Adjutant General and National Guard (ADG). The questionnaire serves as a vendor qualification and background screening tool for potential contractors seeking to provide security services across state facilities. The document establishes baseline requirements for vendor eligibility and security clearance verification as part of the proposal submission process for the fire and alarm security services contract.
The Personal Security Questionnaire functions as a mandatory administrative component of the vendor proposal package, requiring completion by all interested bidders prior to contract award consideration. This form collects vendor organizational information, ownership structure, personnel backgrounds, and other security-related disclosures necessary for the state to assess contractor suitability for handling sensitive security infrastructure and services. Completion and submission of the questionnaire is contingent upon the specific deadlines and submission requirements outlined in the primary RFP and Scope of Work documents associated with the statewide fire and alarm security services opportunity.
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Other files
| File | Type | Posted |
|---|---|---|
| 43ADG-S3865-Insurance Requirements.docx | DOCX document | |
| 43ADG-S3865-Request-for-Proposals~2.docx | DOCX document | |
| Terms-and-conditions-for-services~2.pdf | ||
| 43ADG-S3865 Certification-regarding-lobbying.pdf | ||
| Quote Instructions.pdf | ||
| 43ADG-S3865-reference-questionnaire~2.docx | DOCX document | |
| Terms-and-conditions-for-goods.pdf | ||
| 43ADG-S3865 Standard-form-contract.docx | DOCX document | |
| 43ADG-S3865-Scope of Work~1.docx | DOCX document | |
| 43ADG-S3865 NGNV-Z Attachment.pdf | ||
| 43ADG-S3865-Vendor-Information-Response.pdf |
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Text version
THIS IS A SAMPLE FOR YOUR REVIEW ONLY
NVARNG PERSONAL SECURITY QUESTIONNAIRE
1. Name: ________________, ________________, _________________ Last First Middle (full name)
2. Date of Birth: __________________________ (Month Day, Year)
3. Social Security Number: _________ - ______ - _________
4. Sex: MALE____FEMALE___
5. Driver’s License Number______________________________________
6. Driver’s License State of Issue_________________________________
7. Home Address_____________________________________________
8. City______________________________________________________
9. State_____________________________________________________
10. Place of Birth:__________________________ (City, State, Zip, Country)
11. Employer/Command:________________________________________
12. Phone Numbers: Employer (____) ____-____ Home (____) ____-____
| YES |
| NO |
| NA |
Are you a U.S. Citizen?
Are you a legal resident alien?
Have you ever been barred from any federal government facility or base?
Have you ever been convicted of a felony?
Do you have any outstanding warrants or are you a fugitive from justice?
Are you currently pending trial?
Are you on an approved Dept. of Prisons program? (probation, parole, work release etc.)
Have you ever been convicted on a weapons charge or Theft
13. Individual Requesting Access. I certify that the above information is correct and I agree to allow NVARNG Provost Marshal and/or local commands to perform a local/national security check on me as required.
Signature: ________________________Date:_________________
14. Employer Supervisor/Manager. I certify that the above information has been verified with the individual’s documents; to include a United States issued birth certificate and a United States issued picture identification (e.g., driver’s license, U.S. military ID, Resident Alien Registration Card, Foreign Passport, Foreign Military ID etc.)
Signature: __________________________Date:_________________
15. FMO/NVNG Representative – Print Name_______________________
Signature: __________________________Date:_________________
Project:________________________Location:_________________________
Contract start date:_______________Contract end date:__________________
File details come from the government source that posted it. Updated .