Attachment 4-Contractor Screening Packet Non-Portfolio 11-23.pdf

Contractor Security Screening Packet:

Public Trust‐Low Risk‐1N Contractors OR Public Trust‐Moderate‐Risk‐5N

INSTRUCTIONS:

Please ensure the below documents are included in the submitted package:

(1) DHS Form 11000‐25

(2) *DHS HQ Continuous Vetting Notification - Contractor to review, not required to be submitted

(3) Additional DHS Form 11000‐25 Questions

(4) Optional Form 306

(5) DHS 11000‐9

(6) I‐9, to include the E‐Verify report

(7) DHS Form 11000‐6 Non‐Disclosure

(8) DHS From 11055, Foreign National Screening (if applicable)

(9) Clear copy of the valid State issued Driver’s License or Photo ID Card

All forms can be signed with a wet signature or digitally signed

U.S. Citizens born outside the U.S.:

*This includes Naturalized Citizens, Derived Citizens and U.S. Citizens Born Abroad

(1) A clear photocopy of the U.S. Passport, Naturalization Certificate or Department of State Born Abroad Certificate (if applicable) is required.

Foreign Nationals/Lawful Permanent Residents/Dual Citizens:

**If your applicant is a citizen of another country (Foreign National Visitor, Lawful Permanent Resident (LPR), or Work Visa – anyone that is a non‐US Citizen, OR a Dual Citizen of another country, they must complete Item (7) DHS Form 11055 Foreign National Screening in addition to Items 1 through 6.

(1) A clear photocopy of the Foreign Passport (if applicable)

The foreign passport is the primary document authorized for the initiation of the screening process through DHS. Although other forms of identification can supplement the passport, the passport is the primary means of identification for accessing DHS.

Examples of other identification would be:

(1) LPR Card

(2) Border Crossing Card

(3) Employments Authorization Card (EAC)

(4) Visa

Once complete, submit all documents to the Project Manager, Sponsor, Contracting Officer (CO) or Contracting Officer’s Representative (COR) for sponsorship. The Project Manager, Sponsor, CO or COR will submit to OSPR for processing.

Privacy Act Statement:

Authority: 5 U.S.C. 301; the Homeland Security Act, codified in Title 6 of the U.S. Code; 44 U.S.C. 3101; and Executive Order (EO) 9397; EO 12968; and Federal Property Regulations, issued July 2002.

Purpose: The purpose for collecting and maintaining this information is to allow individuals access associated with DHS/FLETC facilities and perimeter access control, as well as visitor security and management.

Routine Uses: System of Records Notice (SORN) DHS/ALL-024 located at https://www.govinfo.gov/content/pkg/FR-2010-02-03/html/2010-2206.htm.

Disclosure: Disclosure of this information is voluntary. Failure to provide requested information may result in denial of access to the FLETC property.

DHS Continuous Vetting Notification:

The Department of Homeland Security (DHS) is implementing a new federal personnel security reform effort known as “Trusted Workforce 2.0” that will eventually include continuous, real-time vetting of all DHS employees and contractors. This vetting model will reduce delays in onboarding, make it easier for employees and contractors to move between U.S. Government departments or contracts, and provide early detection of risks and threats.

The Office of the Director of National Intelligence and the Office of Personnel Management have directed all U.S. Government departments and agencies to enroll their employees and contractors—regardless of clearance level—in a continuous vetting program by fiscal year 2025. This email is to notify you that you have been enrolled the FBI Rap Back program which ensures employees and contractors’ fingerprints are continuously compared with criminal history and civil records.

You will not notice an immediate difference when you are enrolled in continuous vetting. The systems and entities that will be checked under the Trusted Workforce 2.0 framework are the same as the ones currently and traditionally examined during background investigations, such as arrest records and credit reports. However, rather than conducting periodic reinvestigations every five to 10 years, DHS will conduct automated checks on a continuous basis to make background checks more efficient and effective. These will supplement background investigations, and this new way of processing information will have zero impact on your records.

Continuous vetting does not eliminate the personal responsibility of employees and contractors to report foreign travel, foreign contacts, arrests, and other matters required by any DHS policies, rules, or regulations.

As always, your privacy is, and will remain, paramount. Nothing in this new system will change our commitment to your fundamental rights and liberties as public servants and as Americans. A Privacy Impact Assessment for the information technology system that supports the DHS continuous vetting program, “Privacy Impact Assessment Update for the Integrated Security Management System (ISMS) – Continuous Evaluation,” can be found here: DHS/ALL/PIA-038 Integrated Security Management System (ISMS) | Homeland Security

For additional information, please contact your component’s personnel security office, or the DHS Office of the Chief Security Officer, Personnel Security Program Office at persecpolicy@hq.dhs.gov.

https://www.govinfo.gov/content/pkg/FR-2010-02-03/html/2010-2206.htm https://www.dhs.gov/publication/dhsallpia-038b-integrated-security-management-system-isms https://www.dhs.gov/publication/dhsallpia-038b-integrated-security-management-system-isms mailto:persecpolicy@hq.dhs.gov

Section II: Applicant Information

Please refer to the appended instructions when completing this form. Incomplete forms will be returned. This form must be submitted electronically to by the CO, COTR, or Federal POC.

Section I: Requesting Official/Organization

1. Date of Submission 1 2. DHS Organization 1

3. Type of Request 4. Exit Request Reason 1

5a. CO:

Phone DHS Email 1

5b. COTR/Federal POC:

Phone DHS Email 1

6. Prime Contractor 7. Prime Contract No.

8. Task Order No. 9. PIV Required

10. DHS Organization Structure Code

11. Applicant Name 1

12. Position Title 1

13. SSN 1 14. Gender

15. Place of Birth

16. Date of Birth 17. U.S. Citizen

18. Phone 19. Email

Section III: Position Designation

20. Position Risk Level

Section IV: Position Security Clearance Requirement

21. Security Clearance Level 22. DD254 on File

Privacy Act Information

Authority: 5 U.S.C. 5701-5733, Sections 5701-5733 and Executive Order 9397. Purpose: To facilitate the screening of applicants for contractor positions. Disclosure: Participation is voluntary; however, failure to provide this information may delay processing.

1 Indicates fields required for completing an Exit Request.

Last First Middle

City State Country (if not U.S.)

Name 1

Name 1 Last First

Last First

UNCLASSIFIED//FOR OFFICIAL USE ONLY

Complete this section for UNCLASSIFIED CONTRACTS ONLY.

Note: Low Risk is used for Building Access ONLY, where the position will not require access to DHS systems or information.

Complete this section for CLASSIFIED CONTRACTS ONLY.

Note: A DD254 form is required for all contractor positions requiring a security clearance, and should be on file with ISPB.

Select

Select Select None

Select

Select

Select Select

Select

Select

DEPARTMENT OF HOMELAND SECURITY

CONTRACTOR FITNESS/SECURITY SCREENING REQUEST FORM

DHS Form 11000-25 (7/17) Page 1 of 4

DHS 11000-25 Additional Questions

4. Subcontractor Company:

(if applicable)

If yes, please list all countries:

To be completed by CO/COR/PM

Yes No

Yes No

5. Is the Applicant a Dual Citizen?

6. Does the Applicant require access to IT systems?

(i.e.: FLETC E-Mail, SASS, FLETC Network etc...)

1. Applicant Name:

2. Requested Start Date: 3. Requested End Date:

** A PIV card is no longer required for Tier 1 or Tier 2 positions that DO NOT require access to IT systems. The contractors will still receive a Tier 1 or Tier 2 background investigation, but will be issued a Proximity Card.

OSPR/PER 02/23

7. Is the Applicant working on multiple contracts or Task Orders?

** If working on multiple contracts, a complete packet is required for each contract the Applicant is working on.

NoYes

Form Approved:

OMB No. 3206-0182

This form may also be used to assess fitness for federal contract employment

The information collected on this form is used to determine your acceptability for Federal and Federal contract employment and your enrollment status in the Government's Life Insurance program.

Follow instructions that the agency provides. fore you are appointed you will be asked to update your responses on this form and on other materials submitted during the application process and then to recertify that your answers are true.

All your answers must be truthful and complete.

Either type your responses on this form or print clearly in dark ink. If you need additional space, attach letter-size sheets (8.5" X 11").

Include your name, Social Security Number, and item number on each sheet. We recommend that you keep a photocopy of your completed form for your records.

The Office of Personnel Management is authorized to request this information under sections 1302, 3301, 3304, 3328, and 8716 of title 5, U. S. Code. Section 1104 of title 5 allows the Office of Personnel Management to delegate personnel management functions to other Federal agencies. If necessary, and usually in conjunction with another form or forms, this form may be used in conducting an investigation to determine your suitability or your ability to hold a security clearance, and it may be disclosed to authorized officials making similar, subsequent determinations.

Your Social Security Number (SSN) is needed to keep our records accurate, because other people may have the same name and birth date. Public Law 104-134 (April 26, 1996) asks Federal agencies to use this number to help identify individuals in agency records. Giving us your SSN or any other information is voluntary. However, if you do not give us your SSN or any other information requested, we cannot process your application. Incomplete addresses and ZIP Codes may also slow processing.

ROUTINE USES: Any disclosure of this record or information in this record is in accordance with routine uses found in System Notice OPM/GOVT-1, General Personnel Records. This system allows disclosure of information to: training facilities; organizations deciding claims for retirement, insurance, unemployment, or health benefits; officials in litigation or administrative proceedings where the Government is a party; law enforcement agencies concerning a violation of law or regulation; Federal agencies for statistical reports and studies; officials of labor organizations recognized by law in connection with representation of employees; Federal agencies or other sources requesting information for Federal agencies in connection with hiring or retaining, security clearance, security or suitability investigations, classifying jobs, contracting, or issuing licenses, grants, or other benefits; public and private organizations, including news media, which grant or publicize employee recognitions and awards; the Merit Systems Protection Board, the Office of Special Counsel, the Equal Employment Opportunity Commission, the Federal Labor Relations Authority, the National Archives and Records Administration, and Congressional offices in connection with their official functions; prospective non-Federal employers concerning tenure of employment, civil service status, length of service, and the date and nature of action for separation as shown on the SF 50 (or authorized exception) of a specifically identified individual; requesting organizations or individuals concerning the home address and other relevant information on those who might have contracted an illness or been exposed to a health hazard; authorized Federal and non-Federal agencies for use in computer matching; spouses or dependent children asking whether the employee has changed from a self-and-family to a self-only health benefits enrollment; individuals working on a contract, service, grant, cooperative agreement, or job for the Federal government; non-agency members of an agency's performance or other panel; and agency-appointed representatives of employees concerning information issued to the employees about fitness-for-duty or agency-filed disability retirement procedures.

Public burden reporting for this collection of information is estimated to vary from 5 to 30 minutes with an average of 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to the U.S. Office of Personnel Management, Reports and Forms Manager (3206-0182), Washington, DC 20415-7900. The OMB number, 3206-0182, is valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.

U.S. Office of Personnel Management 5 U.S.C. 1302, 3301, 3304, 3328 & 8716

Optional Form 306 Revised

Previous editions obsolete and unusable

(Provide your full name. If you have only initials in your name, provide them and indicate "Initial only". If you do not have a middle name, indicate "No Middle Name". If you are a "Jr.," "Sr.," etc. enter this under Suffix. First, Middle, Last, Suffix)

(Include city and state or country)

YES NO (If "NO", provide country of citizenship)

(MM / DD / YYYY)

(For example, maiden name, nickname, etc.) (Include area codes)

Day

Night

If you are a male born after December 31, 1959, and are at least 18 years of age, civil service employment law (5 U.S.C. 3328) requires that you must register with the Selective Service System, unless you meet certain exemptions.

7a. Were you born a male after December 31, 1959? YES NO (If "NO", proceed to 8.)

7b. Have you registered with the Selective Service System? YES (If "YES", proceed to 8.) NO (If "NO", proceed to 7c.)

7c. If "NO," describe your reason(s) in item 16.

Form Approved:

OMB No. 3206-0182

This form may also be used to assess fitness for federal contract employment

8. Have you ever served in the United States military? YES (If "YES", provide information below) NO

MM/DD/YYYY) MM/DD/YYYY)

The circumstances of each event you list will be considered. However, in most cases you can still be considered for Federal jobs.

For questions 9,10, and 11, your answers should include convictions resulting from a plea of (no contest), but omit (1) traffic fines of $300 or less, (2) any violation of law committed before your 16th birthday, (3) any violation of law committed before your 18th birthday if finally decided in juvenile court or under a Youth Offender law, (4) any conviction set aside under the Federal Youth Corrections Act or similar state law, and (5) any conviction for which the record was expunged under Federal or state law

9. During the last 7 years, have you been convicted, been imprisoned, been on probation, or been on parole?

(Includes felonies, firearms or explosives violations, misdemeanors, and all other offenses.)

YES NO

10. Have you been convicted by a military court-martial in the past 7 years? YES NO

11. Are you currently under charges for any violation of law? YES NO

12. During the last 5 years, have you been fired from any job for any reason, did you quit after being told that you would be fired, did you leave any job by mutual agreement because of specific problems, or were you debarred from Federal employment by the Office of Personnel Management or any other Federal agency?

YES NO

13. Are you delinquent on any Federal debt? (Includes delinquencies arising from Federal taxes, loans, overpayment of benefits, and other debts to the U.S. Government, plus defaults of Federally guaranteed or insured loans such as student and home mortgage loans.)

YES NO

U.S. Office of Personnel Management 5 U.S.C. 1302, 3301, 3304, 3328 & 8716

Optional Form 306 Revised

Previous editions obsolete and unusable

Form Approved:

OMB No. 3206-0182

This form may also be used to assess fitness for federal contract employment

14. Do any of your relatives work for the agency or government organization to which you are submitting this form?

(Include: father, mother, husband, wife, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half-brother, and half-sister.)

YES NO

15. Do you receive, or have you ever applied for, retirement pay, pension, or other retired pay based on military, Federal civilian, or District of Columbia Government service?

YES NO

16. Provide details requested in items 7 through 15 and 18c in the space below or on attached sheets. Be sure to identify attached sheets with your name, Social Security Number, and item number, and to include ZIP Codes in all addresses. If any questions are printed below, please answer as instructed

If you are applying for a position and received a tentative/conditional job offer or have not yet been selected, carefully review your answers on this form and any attached sheets.

, carefully review your answers on this form and any attached sheets, including any other application materials that your agency has attached to this form. If any information requires correction to be accurate as of the date you are signing, make changes on this form or the attachments and/or provide updated information on additional sheets, initialing and dating all changes and additions.

When this form and all attached materials are accurate, read item 17, complete 17b, read 18, and answer 18a, 18b, and 18c as appropriate.

17. that, to the best of my knowledge and belief, all of the information on and attached to this Declaration for Federal Employment, including any attached application materials, is true, correct, complete, and made in good faith.

that any information I give may be investigated for purposes of determining eligibility for Federal employment as allowed by law or Presidential order. to the release of information about my ability and fitness for Federal employment by employers, schools, law enforcement agencies, and other individuals and organizations to investigators, personnel specialists, and other authorized employees or representatives of the Federal Government.

that for financial or lending institutions, medical institutions, hospitals, health care professionals, and some other sources of information, a separate specific release may be needed, and I may be contacted for such a release at a later date.

17a. Applicant's Signature: Date:

(MM / DD / YYYY)

17b. Appointee's Signature: Date:

(MM / DD / YYYY)

18. Your elections of life insurance during previous Federal employment may affect your eligibility for life insurance during your new appointment. These questions are asked to help your personnel office make a correct determination.

18a. When did you leave your last Federal job? D

18b. When you worked for the Federal Government the last time, did you waive Basic Life Insurance or any type of optional life insurance?

YES NO DO NOT KNOW

18c. If you answered "YES" to item 18b, did you later cancel the waiver(s)? If your answer to item 18c is "NO," use item 16 to identify the type(s) of insurance for which waivers were not canceled.

YES NO DO NOT KNOW

U.S. Office of Personnel Management 5 U.S.C. 1302, 3301, 3304, 3328 & 8716

Optional Form 306 Revised

Previous editions obsolete and unusable

Enter Date of Appointment or Conversion

MM / DD / YYYY

Employment Eligibility Verification Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions.

ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal.

Section 1. Employee Information and Attestation: Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.

Last Name (Family Name) First Name (Given Name) Middle Initial (if any) Other Last Names Used (if any)

Address (Street Number and Name) Apt. Number (if any) City or Town State ZIP Code

Date of Birth (mm/dd/yyyy) U.S. Social Security Number Employee's Email Address Employee's Telephone Number

I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.

Check one of the following boxes to attest to your citizenship or immigration status (See page 2 and 3 of the instructions.):

1. A citizen of the United States

2. A noncitizen national of the United States (See Instructions.)

3. A lawful permanent resident (Enter USCIS or A-Number.)

4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)

If you check Item Number 4., enter one of these:

USCIS A-Number

OR

Form I-94 Admission Number

OR

Foreign Passport Number and Country of Issuance

Signature of Employee Today's Date (mm/dd/yyyy)

If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification on Page 3.

Section 2. Employer Review and Verification: Employers or their authorized representative must complete and sign Section 2 within three business days after the employee's first day of employment, and must physically examine documentation from List A OR a combination of documentation from List B and List C. Enter any additional documentation in the Additional Information box; see Instructions.

List A OR List B AND List C

Document Title 1

Issuing Authority

Document Number (if any)

Expiration Date (if any)

Document Title 2 (if any) Additional Information

Issuing Authority

Document Number (if any)

Expiration Date (if any)

Document Title 3 (if any)

Issuing Authority

Document Number (if any)

Expiration Date (if any)

Certification: I attest, under penalty of perjury, that (1) I have examined the documentation presented by the above-named employee, (2) the above-listed documentation appears to be genuine and to relate to the employee named, and (3) to the best of my knowledge, the employee is authorized to work in the United States.

First Day of Employment (mm/dd/yyyy):

Last Name, First Name and Title of Employer or Authorized Representative Today's Date (mm/dd/yyyy)

Employer's Business or Organization Name Employer's Business or Organization Address, City or Town, State, ZIP Code

For reverification or rehire, complete Supplement B, Reverification and Rehire on Page 4.

Form I-9 Edition 0 / /23 Page 1 of 4

LISTS OF ACCEPTABLE DOCUMENTS

All documents containing an expiration date must be unexpired.

* Documents extended by the issuing authority are considered unexpired.

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

Examples of many of these documents appear in the Handbook for Employers (M-274).

LIST A

Documents that Establish Both Identity and Employment Authorization OR

LIST B

Documents that Establish Identity

LIST C

Documents that Establish Employment

Authorization AND

1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

1. A Social Security Account Number card, unless the card includes one of the following restrictions:

(1) NOT VALID FOR EMPLOYMENT

(2) VALID FOR WORK ONLY WITH

INS AUTHORIZATION

(3) VALID FOR WORK ONLY WITH

DHS AUTHORIZATION

2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)

3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa

2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

4. Employment Authorization Document that contains a photograph (Form I-766) 2. Certification of report of birth issued by the

Department of State (Forms DS-1350, FS-545, FS-240)

3. School ID card with a photograph5. For an individual temporarily authorized to work for a specific employer because of his or her status or parole:

a. Foreign passport; and

b. Form I-94 or Form I-94A that has the following:

(1) The same name as the passport; and

(2) An endorsement of the individual's status or parole as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.

4. Voter's registration card 3. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

5. U.S. Military card or draft record

6. Military dependent's ID card

4. Native American tribal document

7. U.S. Coast Guard Merchant Mariner Card

5. U.S. Citizen ID Card (Form I-197)

8. Native American tribal document

6. Identification Card for Use of Resident

Citizen in the United States (Form I-179)9. Driver's license issued by a Canadian government authority

7. Employment authorization document issued by the Department of Homeland Security

For examples, see Section and Section 1 of the M-274 on uscis.gov/i-9-central.

The Form I-766, Employment Authorization Document, is a List A, Item Number 4. document, not a List C document.

For persons under age 18 who are unable to present a document listed above:

10. School record or report card

6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

Acceptable Receipts May be presented in lieu of a document listed above for a temporary period.

For receipt validity dates, see the M-274.

Receipt for a replacement of a lost, stolen, or damaged List A document.

Form I-94 issued to a lawful permanent resident that contains an I-551 stamp and a photograph of the individual.

Form I-94 with “RE” notation or refugee stamp issued to a refugee.

OR

Receipt for a replacement of a lost, stolen, or damaged List B document.

Receipt for a replacement of a lost, stolen, or damaged List C document.

*Refer to the Employment Authorization Extensions page on I-9 Central for more information.

Form I-9 Edition Page 2 of 4

Supplement A, Preparer and/or Translator Certification for Section 1

Department of Homeland Security U.S. Citizenship and Immigration Services

USCIS

Form I-9

Supplement A OMB No. 1615-0047 Expires 0 /31/2026

Last Name (Family Name) from Section 1. First Name (Given Name) from Section 1. Middle initial (if any) from Section 1.

Instructions: This supplement must be completed by any preparer and/or translator who assists an employee in completing Section 1 of Form I-9. The preparer and/or translator must enter the employee's name in the spaces provided above. Each preparer or translator must complete, sign, and date a separate certification area. Employers must retain completed supplement sheets with the employee's completed Form I-9.

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Signature of Preparer or Translator Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name) Middle Initial (if any)

Address (Street Number and Name) City or Town State ZIP Code

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Signature of Preparer or Translator Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name) Middle Initial (if any)

Address (Street Number and Name) City or Town State ZIP Code

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Signature of Preparer or Translator Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name) Middle Initial (if any)

Address (Street Number and Name) City or Town State ZIP Code

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Signature of Preparer or Translator Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name) Middle Initial (if any)

Address (Street Number and Name) City or Town State ZIP Code

Form I-9 Edition 0 / /23 Page 3 of 4

Supplement B, Reverification and Rehire (formerly Section 3)

USCIS

Form I-9

Supplement B OMB No. 1615-0047 Expires 0 /31/2026

Department of Homeland Security U.S. Citizenship and Immigration Services

Last Name (Family Name) from Section 1. First Name (Given Name) from Section 1. Middle initial (if any) from Section 1.

Instructions: This supplement replaces Section 3 on the previous version of Form I-9. Only use this page if your employee requires reverification, is rehired within three years of the date the original Form I-9 was completed, or provides proof of a legal name change. Enter the employee's name in the fields above. Use a new section for each reverification or rehire. Review the Form I-9 instructions before completing this page. Keep this page as part of the employee's Form I-9 record. Additional guidance can be found in the Handbook for Employers: Guidance for Completing Form I-9 (M-274)

New Name (if applicable)Date of Rehire (if applicable)

Date (mm/dd/yyyy) Last Name (Family Name) First Name (Given Name) Middle Initial

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show continued employment authorization. Enter the document information in the spaces below.

Document Title Document Number (if any) Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.

Name of Employer or Authorized Representative Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy)

Additional Information (Initial and date each notation.)

Date of Rehire (if applicable) New Name (if applicable)

Date (mm/dd/yyyy) Last Name (Family Name) First Name (Given Name) Middle Initial

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show continued employment authorization. Enter the document information in the spaces below.

Document Title Document Number (if any) Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.

Name of Employer or Authorized Representative Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy)

Additional Information (Initial and date each notation.)

Date of Rehire (if applicable) New Name (if applicable)

Date (mm/dd/yyyy) Last Name (Family Name) First Name (Given Name) Middle Initial

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show continued employment authorization. Enter the document information in the spaces below.

Document Title Document Number (if any) Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.

Name of Employer or Authorized Representative Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy)

Additional Information (Initial and date each notation.)

Form I-9 Edition 0 / /23 Page 4 of 4

DHS FORM 11055 (06/17)

INSTRUCTIONS

Requestors shall forward this form to the foreign national(s) being considered for screening. One form may include multiple individuals for the same visit or event by clicking the Add Individual button. Once the foreign national completes the Foreign National Information section, return the form to the Requestor. All fields are mandatory. Failure to complete all the fields may result in a processing delay.

FOREIGN NATIONAL INFORMATION

LAST NAME: FIRST NAME: MIDDLE NAME:

ALIASES:

VISITOR TYPE: GENDER: DATE OF BIRTH (MM/DD/YYYY):

CITY AND COUNTRY OF ORIGIN:

DUAL CITIZENSHIP: YES NO LEGAL PERMANENT RESIDENT: YES NO

COUNTRY(IES) OF CITIZENSHIP:

CITY AND COUNTRY OF RESIDENCE:

PASSPORT COUNTRY OF ISSUE:

PASSPORT NUMBER: EXPIRATION DATE (MM/DD/YYYY):

VISA ISSUANCE LOCATION:

VISA TYPE: VISA NUMBER:

VISA EXPIRATION DATE (MM/DD/YYYY): ALIEN REGISTRATION NUMBER (LPR):

CURRENT EMPLOYER (COUNTRY OR COMPANY):

EMPLOYER TELEPHONE NUMBER: GOVERNMENT OWNED BUSINESS: YES NO

CURRENT EMPLOYER (COUNTRY OR COMPANY ADDRESS

(STREET, CITY, STATE, ZIP CODE, COUNTRY)):

TYPE OF BUSINESS OR ORGANIZATION:

JOB TITLE OR POSITION:

CONTACT NUMBER: EMAIL ADDRESS:

Add Individual Remove Individual

SPONSOR INFORMATION (For Internal Use Only)

NAME (LAST, FIRST, MIDDLE):

JOB TITLE OR POSITION:

DATE OF REQUEST (MM/DD/YYYY): COMPONENT:

OFFICE OR PROGRAM:

EMAIL ADDRESS: TELEPHONE NUMBER:

VISIT OR EVENT INFORMATION (For Internal Use Only)

TYPE OF VISIT/EVENT:

AFFECTED PROGRAM: DATE(S) OF VISIT OR EVENT:

CLASSIFICATION OF ACCESS: DISCLOSURE OF INFORMATION: YES NO

NAME AND TITLE OF VISIT HOST OR AFFECTED FEDERAL EMPLOYEE:

DHS FORM 11055 (06/17)

HOST ORGANIZATION: PURPOSE OF REQUEST:

HOST TELEPHONE NUMBER: LOCATION OF ACCESS:

HOST EMAIL ADDRESS:

BACKGROUND (DESCRIBE THE CIRCUMSTANCES SURROUNDING THE SCREENING REQUEST)

PRIVACY ACT STATEMENT

Authority: The collection of this information is authorized by 6 U.S.C. § 341 (2010); Security Executive Agent (SecEA) Directive (SEAD) 3; DHS Policy Directive 121-11, Foreign Access Management; and DHS MD 11052, Internal Security Program.

Purpose: DHS will use this form to screen a foreign national and determine if he or she should be granted access to DHS information, personnel, systems, and facilities.

Routine Uses: The information will be used by and disclosed to DHS Security personnel, contractor employees, or other agents responsible for evaluating foreign nationals who request access to DHS. DHS may share the information when appropriate and permissible under a routine use in the DHS/ALL/PIA-048(a) Foreign Access Management System (FAMS) and the DHS/ALL-024 Department of Homeland Security Facility and Perimeter Access Control and Visitor Management System of Records Notice, 75 FR 5609 (February 3, 2010).

Disclosure: Providing the requested information is voluntary, but failure to do so could result in the denial of the foreign national’s access to DHS information, personnel, systems, and facilities.

Submit by Email content

Department of Homeland Security Contractor Security Orientation

Presented by:

DHS Office of the Chief Security Officer Compliance / Standards and Training Division

IMPORTANT:

The contents of this training guide are

UNCLASSIFIED.

All information and instructions contained herein are in accordance with Executive Order 13526, 32 CFR, part 2001, DHS Management Directive (MD) 11042.1, DHS IT policies and MD 11056.1: DHS policy regarding the recognition, identification, and safeguarding of Sensitive But Unclassified Information (SBU). The policies and directives referenced in this guide are applicable to all persons who are permanently or temporarily assigned, attached, detailed to, employed, or under contract with

DHS.

DO NOT duplicate, copy, or redistribute any information contained in this guide without written permission from the DHS Office of Security Compliance, Standards and Training Branch.

securitytraining@hq.dhs.gov

Page | 1 Department of Homeland Security Office of The Chief Security Officer C/S&TD Contractor Security Orientation Guide V 1.3

Introduction

The Office of the Chief Security Officer would like to welcome you to the Department of Homeland Security. This Contractor Security Orientation was developed to provide contractors with general information regarding DHS asset protection policies and safeguarding procedures. In addition to the information contained herein, be sure to review your specific operational policies and procedures, as they may contain additional helpful information and/or details.

Once you have read the information provided in this orientation, you will be able to:

• The Department of Homeland Security’s mission

• Identify what DHS protects and the types threats being protected

• Identify the basic principles of each major security discipline

• Discuss how OPSEC applies to you and the DHS mission

• Explain your roles and responsibilities in accordance with the Department of

Homeland Security's mission to protect America's assets, including Sensitive But Unclassified and Classified National Security Information.

• Understand the terms "Need-to-Know" and "unauthorized disclosure"

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Protecting America’s Assets Skip to main content The department of Homeland Security employs a comprehensive security program to ensure the operational integrity and protection of our assets. The acronym "PIE-FAO" is an easy way to remember what these assets are.

• Personnel: People are our most important asset. Without the protection of people, some of the other items listed here could also be compromised.

• Information: In all DHS environments, information is something we all work with on a daily basis; both classified and unclassified.

• Equipment: From computer network systems and telecommunications, to facsimiles and COMSEC equipment, we use these things on a daily basis to process and disseminate the information we work with.

• Facilities: We need to protect places we work, process, and store information and equipment. No two facilities are alike.

• Activities: Many activities also need protection. This includes our travel, meetings, working groups, and project teams that we may be involved with.

• Operations: Protecting the continuity of essential security operations, like immigration and terrorism task force operations is crucial.

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Identifying Threats

There are primarily two types of threats we are most concerned with. The first type of threat is known as a natural disaster - an adverse condition or event imposed by nature. without certain security efforts, the after effect of natural disasters could leave our facilities damaged, creating vulnerability to further threats and compromises. Normally, these happenings are not predictable, therefore we have to be emergency prepared and establish and maintain a Continuity Of Government (COG) and Continuity of Operations Plan (COOP).

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The second type of threat we need to be concerned with is the human threat. The human threat ranges from International, domestic, gangs, to the insider threat. International and Domestic Terrorist threats run the gamut; from hate-filled white supremacists…to highly destructive eco-terrorists…to violence-prone anti-government extremists…to radical separatist groups. U.S.

Immigration and Customs Enforcement (ICE) is continually working to rid our streets of violent foreign-born gang members who are in our country illegally and represent a threat to our community and government.

Are there any other kinds of threats you can think of? Maybe you’ve heard of the term “insider threat”? Executive Order (EO) 13587 directs U.S. Government Executive Branch agencies and departments to establish an Insider Threat Task Force to develop a government-wide Insider Threat program, to protect classified national security information. But what exactly is an Insider threat? In the next section, we will briefly discuss the insider threat and what you can do to identify and report suspected insider threats.

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Insider Threat

The National Insider Threat Task Force (NITTF) provides the following definitions to better understand and identify insider threats.

• An insider is a person with authorized access to any United States Government resource to include personnel, facilities, information, equipment, networks or systems.

• The Insider Threat is identified as someone who uses his/her authorized access, wittingly or unwittingly, to do harm to the security of the United States.

Top, left to right: Edward Joseph Snowden, Nidal Malik Hasan, and Chelsea Manning Bottom, left to right: Aaron Alexis, David Petraeus

Anyone with positioning and/or access could be an insider threat, either through intentional or unintentional efforts. In some cases, simply a lack of training, knowledge of experience can create security vulnerabilities. As a contractor for the Department of Homeland Security, you may also be required to complete Insider threat-specific training and direct your Insider Threat matters/questions to: dhs_insider_threat_program@hq.dhs.gov or (202) 447-4200.

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Operations Security (OPSEC)

Operations Security (OPSEC) is systematic and proven process by which the U.S.

Government and its supporting contractors can deny to potential adversaries’ information about capabilities and intentions by identifying, controlling, and protecting generally unclassified evidence of the planning and execution of sensitive Government activities.

Being able to identify indicators and following your Operational Security (OPSEC) processes are essential in protecting information about missions, activities, and operations.

We can never underestimate the capabilities or strength of conviction of an adversary. Nothing is more dangerous than someone who is willing to die for a cause. Who is the adversary? It is important to remember that the U.S. Government has many adversaries with bad intentions. For example, foreign intelligence services continue to collect information on us that could be used to hurt us in the future. We sometimes only focus on what just happened, but it is a certainty that our adversaries will continually look for and find any weak links.

Their intent may be to:

• Collect Information

• Conduct Espionage

• Disrupt/Impact Service

• Secure Criminal advantage

• Terrorism

• Obtain Publicity/Propaganda

• Gain Competitive Advantage

• Exploit Personnel/Vulnerabilities

• Offensive Cyber Operations

Think about what someone may observe regarding your activities. What do you do when you go to work? What are you revealing by your predictable routines and the way you do business?

These are called "indicators". As a DHS contractor, you are responsible for identifying the indicators and vulnerabilities that may exist in your activities and operations, so that the OPSEC Process can be applied effectively.

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The OPSEC Process is a 5-step evaluation methodology that involves: identifying critical assets, such as information; analyzing the threat; analyzing vulnerabilities; assessing risk;

and applying countermeasures. Do you currently apply OPSEC in your daily activities?

What kinds of routine activities could be measurably observed by others? Look at the example diagram below and determine if your OPSEC is working to help protect critical information.

1. Identify Your Critical Information

What do you want to protect and why? Is it governed by a regulatory requirement?

Can it be defined as sensitive but unclassified?

2. Analyze the Threat

Who wants the sensitive information? Is there more than one adversary?

What is their objective? What will they do to get to your sensitive information?

What methods will they use to get it?

3. Analyze the Vulnerabilities

How is your information vulnerable? How is it protected or not protected?

Is it properly protected?

4. Assess the Risk

Is the risk great enough to do something about the threat? How would the loss of sensitive data affect your operations? What would be the cost of losing sensitive information?

5. Develop and Apply Countermeasures

What countermeasures will block access to your information?

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Personnel Security

Although there are many tasks associated with Personal Security, some basic tasks include:

• Conduct background investigations of federal and contract employees to determine integrity and trustworthiness

• Verify security clearances for DHS employees and contractors

• Process incoming and outgoing Perm-Certs

• Provide continuous evaluation reporting guidance

Does the screen below look familiar? It should. If you’re reading this guide, it was likely one of your first encounters with the Personnel Security information collection process.

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Along with your initial inquiry, you may be required to report additional information, to include, but not limited to:

• unofficial foreign travel / contacts

• criminal conduct / activity

• marital status, legally recognized civil union, domestic partner, cohabitant(s), and immediate family members

• adverse information

What is Adverse Information?

It is any information that may reflect unfavorably on the trustworthiness or reliability of an individual and suggests that their ability to safeguard classified information may be impaired. Policy requires clearance holders to report adverse information immediately.

If you hold a National Security position, then you are required to self-report any derogatory activity on a good-faith basis. However, a person determined to conceal negative behavior may not self-report and therefore conceal the negative behavior until their next Periodic Reinvestigation (PR).

Continuous Evaluation addresses this by conducting the same sorts of automated and unannounced records checks you agreed to as part of your original investigation, on a recurring basis. You will still be required to report certain categories of life events, but the automated records checks will drastically shorten the interval between the occurrence and reporting of an incident.

Continuous Evaluation Continuous Evaluation (CE) is a mandated personnel security process, implemented by DHS Personnel Security offices, to review personnel who have been determined to be eligible for access to classified information or hold a sensitive position. CE is part of the security clearance reform effort to modernize personnel security processes and increase the timeliness of information between the cycles of periodic reinvestigation. Current PR cycles run approximately every five years. CE leverages automated, unannounced record checks on a recurring basis and applies standardized business rules to identify security-relevant information that assists in the assessment of an individual's on-going eligibility for access to classified information or eligibility to hold a sensitive position. The types of records collected through CE are the same as those currently checked for personnel security purposes (to include: credit, criminal activity, commercial, eligibility, foreign travel, suspicious financial activity, and terrorism).

CE shall supplement, not replace, traditional periodic reinvestigations.

NOTE: If you have signed the SF-86, Questionnaire for National Security Positions, dated 2010 or later, you have already given your consent for CE and the process will appear seamless.

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Physical Security

Physical Security encompasses the full range of protective measures designed to safeguard personnel and prevent unauthorized access to, and the loss, theft, destruction, sabotage, or compromise of equipment, facilities, material, and information.

Physical Security controls typically include, but are not limited to:

• Security Personnel

• Supporting infrastructure

• Contingency and emergency support

• Access Control (keycards, doors/locks, readers, etc.)

• Intrusion Detection/Surveillance Systems

• Operational Security Procedures

Most importantly, the continued development and engagement of your security mindset is key to the success of our physical security mission. With your help and dedication, we can all provide a safer and more secure environment.

Your role and responsibility start with strict adherence to established security policies. Additionally, you can stop unauthorized access and help maintain a secure workplace by:

• Wearing your access badge appropriately

• Reporting lock or door failures

• Securing your workspace/terminal

• Challenging unknown/non-badged individuals

• Reporting suspicious people, packages, and activities

• Preventing tailgating and/or piggybacking

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Always wear your badge/PIV properly. Badges/PIVs should be visibly worn between the neck and waist. Protect your badge against theft or duplication and put it away when not in use.

Leaving your badge/PIV in plain view could provide sufficient information to anyone able to use

it. Challenge unknown and/or non-badged persons. Simply ask them if they have their badge/PIV or whether they are being escorted in unauthorized spaces. If you are dissatisfied with the response given, report them immediately to security. Lastly, remember to lock your computer and remove your badge/PIV when leaving your workspace.

Another important…