PII_Sheet.pdf
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- Attached to
- Network Cabling Upgrade Federal contract opportunity
- Solicitation number
- AG-32SC-S-17-0027
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Personal Identity Information
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Text version
Fingerprint Check Only________ Background Investigation/LincPass_______ The USDA Credential Matrix indicates that a performing non-employee requires a LincPass, or in some cases, a fingerprint check. The information collected on this Personal Identity Information (PII) sheet is required for both processes. This information is to be collected and transmitted in accordance with The Privacy Act of 1974.
Instructions: Enter the information below for the non-employee applicant. If form is incomplete or if required attachments are not included, package will not be processed and will be returned to Requestor.
*Required Attachments – if not included, form will not be processed and will be returned to Requestor
� OF-306
� Resume (if LincPass/Investigation required) � Finger Print Charts (2)
*Company/Organization Name/Revocable Permit or Contract#:
Indicate number & expiration date *Area/Location/Duty Station (of employee; city and state)
*USDA POC Name, Title, Address, and Telephone Number
*Sponsor Name, Address, and Telephone Number
*Name(s) of Individual to Receive Finger Print Results (AO and/or HR Liaison)
*Length of Appointment (NTE Date)
*Type of Investigation Required for ARS Position
*Position to Which Appointed *Existing Background Investigation? Yes/No/Don’t Know. If yes, enter the agency that conducted the investigation (e.g.
USDA, Treasury, Energy, etc.).
*Name (Last, First, Middle): Enter applicant's complete name as it appears on their government-issued ID (e.g. driver’s license or passport). If the information doesn’t match, the non-employee will encounter problems during enrollment and may have to reapply.
*Date of Birth (mm/dd/yyyy) *Place of Birth: City/State. If outside U.S., enter City/Country.
*Gender
*Social Security Number
*Country of Citizenship
*Home Address: Enter the full address as it appears on the applicant’s government-issued ID.
*Phone/Type (e.g. Business)
*E-mail Address (business e-mail preferred) Required for enrollment notification. If the applicant does not have a business email address, enter the address of the person who will manage enrollment activities, e.g. Security Officer or Supervisor.
*PO Number/TAS Number Please Hand Carry to POC/Sponsor
PSS Staff Use Only Date Cleared: _____________________
Recipient: ________________________
| CompanyOrganization NameRevocable Permit Indicate number expiration date: |
| AreaLocationDuty Station of employee city and state: |
| USDA POC Name Title Address and Telephone Number: |
| Sponsor Name Address and Telephone Number: |
| Names of Individual to Receive Finger Print Results AO andor HR Liaison: |
| Length of Appointment NTE Date: |
| Type of Investigation Required for ARS Position: |
| Position to Which Appointed: |
| Existing Background Investigation YesNoDont Know If yes enter the agency that conducted the investigation eg USDA Treasury Energy etc: |
| Name Last First Middle Enter applicants complete name as it appears on their governmentissued ID eg drivers license or passport If the information doesnt match the nonemployee will encounter problems during enrollment and may have to reapply: |
| Date of Birth mmddyyyy: |
| Place of Birth CityState If outside US enter CityCountry: |
| Gender: |
| Social Security Number: |
| Country of Citizenship: |
| Home Address Enter the full address as it appears on the applicants governmentissued ID: |
| PhoneType eg Business: |
| Email Address business email preferred Required for enrollment notification If the applicant does not have a business email address enter the address of the person who will manage enrollment activities eg Security Officer or Supervisor: |
| PO NumberTAS Number: |
| Recipient: |
| Date Cleared: |
| Check Box1: Off |
| Check Box2: Off |
| Check Box3: Off |
| Check Box4: Off |
| Check Box5: Off |
File details come from the government source that posted it. Updated .