5-GSS26009A APPENDIX D - DOC SECURITY CLEARANCE APPLICATION.pdf
PDF 205 KB Posted
- Attached to
- Motor Oil, Lubricants, and Antifreeze
- Solicitation number
- GSS26009A-MOTOR_OIL
- Issued by
- Delaware
About this file
The document is a Security Clearance Application form from the Delaware Department of Correction (DOC) designed for individuals seeking access to correctional facilities. The form is applicable for various types of access, including one-time visits, occasional volunteer or service provision (less than 3 days per week or 165 days per year), and frequent/long-term volunteer or service provision (at least 3 days per week or 165 days per year). Applicants must provide comprehensive personal information, criminal history details, and justification for their security clearance request. Volunteers, interns, and professional service visitors are required to attach a letter from their sponsoring organization on agency letterhead, signed by the director, including the applicant's name, title/role, and program name.
The form includes detailed sections for personal information, criminal history, and justification for the security clearance request. Applicants must disclose any arrests other than traffic tickets, whether convicted, dismissed, or pardoned, and indicate if they are currently under Department of Correction supervision or know anyone incarcerated at a DOC facility. The final section requires the applicant's signature and understanding that DOC authorities will verify criminal record information, with the potential for application rejection. The document also includes a section for DOC use only, where investigators will record the results of DELJIS (Delaware Justice Information System) and NCIC (National Crime Information Center) records checks, and determine whether to approve or deny the security clearance request based on specific criteria such as criminal convictions, pending litigation, or institutional misconduct.
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| 4-GSS26009A APPENDIX C1 - Pricing (BT-49LQ).xlsx | XLSX spreadsheet | |
| 6-GSS26009A APPENDIX C2 - Equipment Deposits and Credits (BT-78DU) (1).xlsx | XLSX spreadsheet | |
| 1-READ ME FIRST GSS26009A Appendix A - Online Bid Submission Portal Instructions.pdf | ||
| 2-GSS26009A ITB.pdf | ||
| 3-GSS26009A APPENDIX B - Vendor Forms.pdf |
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Text version
SECURITY CLEARANCE APPLICATION
DELA WARE DEPARTMENT OF CORRECTION
PLEASE PRINT CLEARLY
WHO SHOULD COMPLETE THIS FORM:
i. Applicants requesting one-time access or occasional access (whether for one facility or multiple facilities)
ii. Applicants requesting a badge for access to one or more facilities (frequent access for period of 1 year or more) Note: These applicants will be directed to Human Resources after this form is approved
m. Individuals requesting to schedule an offender visit may be asked to complete this form.
Pai:;e 1 of3
Volunteers, interns and professional service visitors must attach a letter from their sponsoring organization. Letter must be on agency letterhead, signed by the agency's director and include the name and title/role of the applicant and the name of the program.
WHO SHOULD NOT COMPLETE THIS FORM:
(1) Attorneys
(2) Employees ofDOC's contracted medical/behavioral health provider (please contact DOC's Human Resources directly)
SECTION 1: PERSONAL INFORMATION & CRIMINAL HISTORY
NAME: _________________________________ _
(LAST) (FIRST) (MIDDLE)
PLEASE LIST ALL OTHER NAMES YOU HA VE USED INCLUDING MAIDEN, NICKNAMES AND RELIGIOUS
NAMES:
DOB: ____ _ PLACE OF BIRTH: ________ _ _ _ SSN#:
SEX: MALE / FEMALE RACE: _____ DRIVER'S LICENSE#: _________ STATE: __ _
ADDRESS:
CITY: _______________ _
PHONE: HOME:<�-�) _______ _
EMAIL:
APT#: ------
STATE: ZIP: ----- -----
WORK:<�--�) _______ _
PLEASE LIST WHICH FACILITY(IES) YOU ARE REQUESTING ACCESS TO:
PLEASE ELECT TYPE OF ACCESS REOUE TED
Offender Visit
_ One Time Access (i.e. single event) * No badge issued _ Occasional Volunteer or Service Provision (Less than 3 days per week or less than 165 days per year for a period of one year or less) * No badge issued _ Frequent/Long Term Volunteer or Service Provision (At least 3 days per week or 165 days per year for a period of one year or more) * You will be directed to HR to fill out a badge application packet after this form has been approved by the respective DOC Bureau Chief
DO YOU HA VE ANY ARRESTS FOR CHARGES OTHER THAN TRAFFIC TICKETS (WHETHER CONVICTED, DISMISSED, NOLLE PROSSED, OR PARDONED)? NO/YES (IF YES, COMPLETE BELOW). IF YOU NEED MORE
ROOM, PLEASE ATTACH A SEPARATE SHEET.
COUNTRY:
DATE: ______ _
OFFENSE: ___________ _
APPENDIX D
Kimberly.Girantino Typewritten Text
Untitled
File details come from the government source that posted it. Updated .