9.) Contractor Pre-Employment Questionnaire.pdf
PDF 17 KB Posted
- Attached to
- SV0177-25, Roof Bar Joist Reinforcement
- Solicitation number
- 1600002462
About this file
The document is a Contractor Pre-Employment Questionnaire designed to collect detailed background information from potential contractors. The form requires applicants to disclose information about their criminal history, including: 1) relationships with current inmates, 2) pending criminal charges, 3) past incarceration or correctional supervision, and 4) any incidents involving sexual misconduct or sexual abuse. Applicants must provide specific details for any affirmative responses, including dates, locations, charges, and current status. The form concludes with a certification statement where the applicant attests to the truthfulness of their responses, and provides a space for signature and date.
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CONTRACTOR PRE-EMPLOYMENT QUESTIONNAIRE
NAME: __________________________________ Social Security #: (last 4 digits only) _________
ADDRESS: ______________________________________________
1. Do you know or are you related to anyone who is currently an inmate in this or any other correctional institution?
Yes _____ No _____
If yes, please provide names, locations, relationships, and describe any current or anticipated contact with the inmate(s).
2. Are there any criminal charges currently pending against you?
Yes _____ No _____
If so, please provide charge, date arrested, court dates, docket numbers and any other pertinent details.
3. Are you now or have you ever been incarcerated or under correctional supervision (including home detention, probation, work release, etc.)?
Yes _____ No _____
If so, please provide dates of incarceration, sentence, location, charges, current status and any other pertinent details.
4. Have you ever been arrested, charged, and convicted of any incident involving sexual misconduct or sexual abuse of any type (include accusations against you which resulted matters resolved by a civil court)?
Yes _____ No _____
If so, please provide dates of incarceration, sentence, location, charges, current status and any other pertinent details.
CERTIFICATION: I certify that all of the statements made on these pages are true, complete, and correct to the best of my knowledge and belief and are made in good faith.
Signature: ________________________________________ Date: _____________
File details come from the government source that posted it. Updated .