Sexual Misconduct Self-Certification (2) (1).pdf
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About this file
This is a Sexual Misconduct Self-Certification form required by USAID South Sudan for contractor personnel. The form outlines USAID's zero-tolerance policy for sexual misconduct and requires individuals to certify whether they have had any disciplinary actions, terminations, or resignations related to sexual misconduct within the previous 3 years.
The document defines sexual misconduct comprehensively, including sexual abuse, assault, exploitation, harassment, intimate-partner violence, stalking, and voyeurism. It requires disclosure of any disciplinary actions from current or previous employers, including government contract terminations. If answering "Yes" to any incidents, a separate explanatory document must be submitted. The form requires the individual's printed name, signature, and date, with a warning that false information may result in contract termination and legal consequences. USAID notes that award decisions will not be based solely on the responses provided.
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Sexual Misconduct Self-Certification
The U.S. Agency for International Development (USAID) has zero tolerance for sexual misconduct.
USAID affirms that sexual misconduct is counter to our Agency's core values, and we will take necessary steps to prevent and address sexual misconduct within our workforce and programs, while also taking into account survivors' needs.
"Sexual misconduct" is an umbrella term that encompasses any inappropriate behavior of a sexual nature or that is sex-based, including sexual abuse, sexual assault, sexual exploitation, sexual harassment, intimate-partner violence, stalking, voyeurism, and any other such conduct that is sexual in nature or that is sex-based which is nonconsensual or has the purpose or effect of threatening, intimidating, denigrating, or coercing a person. Actions that constitute sexual misconduct include, but are not limited to, the following: physical, verbal, non-verbal, and/or written acts, including comments, jokes, gestures, the posting of images, sexual advances, the offering of sexual incentives, and the threat of consequences for the refusal of sexual advances. This includes any disciplinary actions taken against you from your current or previous employer(s), terminations on grounds of sexual misconduct, or resignations taken in lieu of termination on grounds of sexual misconduct.
In the last 3 years, has there been a disciplinary action taken against you from your previous or current employer(s), terminations on grounds of sexual misconduct, or resignations in lieu of termination on grounds of sexual misconduct? Termination includes a termination of a previous contract with the government: NO YES
If “Yes”, please explain in a separate document and submit.
Note: USAID will not make award decisions based solely on the responses and information provided.
You certify that all the information provided is true, correct, complete, and made in good faith.
False or fraudulent information may result in you being eliminated from consideration for this contract, or grounds for termination of the contract, and may be punishable to the full extent of the law.
Print Name (Last Name, First)
Signature
Date
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File details come from the government source that posted it. Updated .