6-86c Questionnaire Form.pdf

PDF 264 KB Posted

Attached to
Coating Roof Decks and Place Brick Filters IAW SOW & DWG
Solicitation number
246-25-Q-0067
Issued by

About this file

The document is a Background Investigation form from the Oklahoma City Area Indian Health Service. It requires comprehensive personal history information, including a detailed residence history for the past 5 years, with checkboxes for states lived or worked in, and sections for other names used and contact details. The form is part of a broader background investigation process, likely associated with the federal contract opportunity for roof coating work at the Clinton Indian Health Center, which requires potential awardees to complete this background screening as part of the hiring or contract award process.

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Text version

OKLAHOMA CITY AREA INDIAN HEALTH SERVICE

INVESTIGATION

Indiana Montana Ohio

Iowa Nevada Rhode Island

Kansas New Hampshire South Dakota

Kentucky New Jersey Tennessee

Michigan New Mexico Texas

Minnesota New York Utah

Mississippi North Carolina West Virginia

Alabama

Alaska

Arkansas

California

Colorado

Delaware

Idaho

Illinois Missouri North Dakota Wyoming

MONTH/YEAR - MONTH/YEAR

Present

Alabama: Off
Alaska: Off
Arkansas: Off
California: Off
Colorado: Off
Delawre: Off
Idaho: Off
Illinois: Off
Indiana: Off
Iowa: Off
Kansas: Off
Kentucky: Off
Michigan: Off
Minnesota: Off
Mississippi: Off
Missouri: Off
Montana: Off
Nevada: Off
New Hampshire: Off
New Jersey: Off
New Mexico: Off
New York: Off
North Carolina: Off
North Dakota: Off
Ohio: Off
Rhode Island: Off
South Dakota: Off
Tennessee: Off
Texas: Off
Utah: Off
West Virginia: Off
Wyoming: Off
Z l vš oÀ vlŒ ÁŒl v À š š v šZ š ñ Ç ŒW: Off
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