Appendix 1-Contractor Employee Background Check Verification Solicitation Form.pdf
PDF 74 KB Posted
- Attached to
- Fort Indiantown Gap Armed Security Guards
- Solicitation number
- DMVA-RFP003099
- Issued by
- Pennsylvania
About this file
This document is a Contractor Employee Background Check Verification Form issued by the Pennsylvania Department of Military and Veterans Affairs for the Fort Indiantown Gap Armed Security Guards contract. The form requires the apparent low bidder to affirm compliance with Commonwealth Standard Terms and Conditions regarding background checks, specifically Section V.43 Contract-036.1. The contractor must conduct FBI background checks for all employees who will perform services at the contract location, including those without recent Pennsylvania residency.
The form mandates that background checks be completed for all contracted employees before starting work, with new employees requiring a background check or FBI check five days prior to their start date throughout the contract duration. The contractor must maintain documentation of these background checks and be prepared to provide them to the department in the event of an investigation or audit. The authorized representative must sign the form, attesting to the accuracy of the information and understanding that submitting false or misleading information may result in legal sanctions.
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Text version
CONTRACTOR EMPLOYEE BACKGROUND CHECK VERIFICATION FORM
Date: ________________
Business or Organization Name (Employer) ______________________________________________________
Address___________________________________________________________________________________
City____________________________________________State____________________Zip Code___________
Solicitation Number___________________________________________________
Contract Location______________________________
As the apparent low bidder for the referenced Solicitation Number, I hereby affirm that as of the above date, our company is in compliance with Commonwealth Standard Terms and Conditions Section V.43 Contract-
036.1 Background Checks (February 2016) and in addition, a FBI background check for residency not held within the past (2) consecutive years in PA, through https://www.psp.pa.gov/Documents/Public%20Documents/criminal_history/Request%20for%20Criminal%20Record%2 0Check%20-%20SP%204-164%202017.doc.
All employees contracted with our company that will perform services listed in the above contract location, background checks have been conducted and are in compliance with the above mentioned terms.
It is also agreed that any new employee who will perform services at the above listed contract location, will have a background check and/or FBI check conducted (5) five days prior to the start date throughout the duration of the contract. Documentation confirming background check and/or FBI checks will be maintained for all contract employees who will perform services in the above mentioned contract. In the event of an investigation or audit the vendor will be required to provide the documentation to the Department.
I, _____________________________, authorized representative of the company above, attest that the information contained in this verification form is true and correct and understand that the submission of false or misleading information in connection with the above verification shall be subject to sanctions provided by the law.
Authorized Representative Signature https://www.psp.pa.gov/Documents/Public%20Documents/criminal_history/Request%20for%20Criminal%20Record%20Check%20-%20SP%204-164%202017.doc https://www.psp.pa.gov/Documents/Public%20Documents/criminal_history/Request%20for%20Criminal%20Record%20Check%20-%20SP%204-164%202017.doc
| Date: |
| Business or Organization Name Employer: |
| Address: |
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| Solicitation Number: |
| Contract Location: |
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| undefined: |
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