08 - AC_Form_3370-2.pdf

CONTRACT EMPLOYEE CLEARANCE RECORD

Privacy Act: In compliance with the Privacy Act of 1974, the following information is provided. Solicitation of the information on this form is authorized by 5 USC 552a.

1. Employee’s Full Name 2. DOB 3. Routing Symbol (Duty Org.)

4. Contract Number 5. Contract Company’s Name and Local Telephone Number

6. ACTION RESIGNATION OTHER TRANSFER TO

7. Instructions: Each item subject to clearance must be signed by the clearing official. If an item is not required in an employee’s position, the cognizant Contracting Officer’s Representative may indicate “not applicable” and sign in the “Signature of Clearing Official” block.

OFFICE BLDG/RM ITEMS SUBJECT TO CLEARANCE DATE Printed Name, Routing Symbol and

SIGNATURE OF CLEARING OFFICIAL

CTR’s Duty Organization

Issued personal property (I.T. equipment, uniforms, etc.)

APS-322

Clearance for

ATO supported CTR’s

ARB 132

ADP – equipment and network access/User-ID’s for ATO LOB.

ESC Clearance Office for ESC supported CTR’s organizations MPB 101

Remedy, Network/Active Directory, Outlook, Voice Mail, ESC Data Center, EASE Mainframe, etc.

Voice Mail (Messages Cleared / Passwords Reset) User-ID’s for financial systems. (i.e.:

Delphi, ESC PRISM, Markview, GOVTRIP, etc.) If not required in employee's position, supervisor may sign.

Acquisition Automation

Team, AAQ-710 for all

CTR’s

MPB 304 PRISM-login rights and user-ID’s.

Security Command Center for all CTR’s

Bldg 230 Rm

ID cards, access cards, accountable keys, reserved handicap parking, and vehicle decals.

8. CERTIFICATION OF EMPLOYEE: I certify that I have returned all government property entrusted to me.

8a. Former employee not available for signature.

9. CERTIFICATION OF CONTRACT PROJECT MANAGER:

I certify that to the best of my knowledge and belief, all government property, records, and indebtedness entrusted and/or issued to the above employee have been accounted for, and computer access and passwords have been deleted, except as noted.

Signature Date Signature Date

Notes:

1.

2.

Sign in the appropriate certification space if all items cleared. If any accountable item is not cleared, note in the space provided or provide details on an attachment to this form.

This form shall be maintained in the official contract file. The Contract Project Manager is responsible for distributing completed copies of the form to the Contracting Officer (CO), COR, Personnel Security, and the clearing contract employee.

THE FOLLOWING IS FOR USE BY THE CONTRACTING OFFICER

Date Withholding Action Initiated: Date Action Completed:

Amount Withheld: $

AC Form 3370-2 (4/15) Supersedes previous edition