6309 Attachment F_Facility Security Clearance Background Check (DOC 2430).pdf

This is a Facility Security Clearance Background Check form from the Wisconsin Department of Corrections, issued under Governor Scott Walker and Secretary Jon E. Litscher. The document serves as a standardized form for conducting criminal background checks on individuals seeking admission to correctional facilities within Wisconsin's state corrections system.

The form is designed to collect comprehensive personal information including full names, former names, dates of birth, driver's license numbers, and contact details for individuals who will be present at correctional facilities. It requires contractors or organizations to provide details about their personnel, including the purpose of facility visits, vehicle information, and contact information. The form includes provisions for tracking when background checks are completed and emphasizes that all individuals listed are subject to security screening and potential rejection by facility Security Directors. The document references compliance with federal regulations including 28 CFR s.20.33 regarding criminal background information distribution and motor vehicle record access under 18 U.S.C. § 2721.