Atch 6 - HAFB Site Visit Background Consent.docx
DOCX document 213 KB Posted
- Attached to
- Concrete Target Fabrication Federal contract opportunity
- Solicitation number
- FA9101-24-Q-B049
About this file
This document is a Background Check Consent Form that authorizes the U.S. Government (United States Air Force) to conduct background checks to determine an individual's eligibility to access Holloman Air Force Base in New Mexico. The form requires the individual's printed legal name, social security number, birth date, citizenship status, and signature. It states that the information provided will be kept confidential and used solely to assess the individual's access eligibility, which could be impacted by conditions such as misconduct, arrests, or open investigations.
The related federal contract opportunity is for Concrete Target Fabrication, with Solicitation Number FA9101-24-Q-B049, issued by the Department of the Air Force Materiel Command Test Center.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Target Fabrication QA V2 Site Visit Added.pdf | ||
| Atch 8 - DO 01 RFP V2.pdf | ||
| Target Fabrication Site Visit Results.pdf | ||
| Target Fabrication QA V1.docx | DOCX document | |
| Target Fabrication QA V1.docx | DOCX document | |
| Target Fab 2024 Combined Synopsis Solicitation.docx | DOCX document | |
| Atch 7 - Use_of_non-government_advisors.pdf | ||
| Atch 8 - DO 01 RFP.pdf | ||
| Atch 1 - Requirements Document Concrete Target Fabrication 2024.pdf | ||
| Atch 2 - Provisions and Clauses FA910124QB049.pdf | ||
| Atch 3 - Holloman Specific Language.pdf | ||
| Atch 4 - Target Fab 2024 Evaluation Plan.pdf | ||
| Atch 5 - Engineering Drawing Package.pdf |
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Text version
BACKGROUND CHECK CONSENT FORM
I, , (Name – typed/printed) Hereby authorize the U.S. Government (United States Air Force) to conduct background checks confirming my eligibility or ineligibility to gain access to Holloman Air Force Base, New Mexico.
Examples of conditions that may identify ineligibility to access the installation include, but are not limited to, substantiated misconduct, conviction or arrests for violent behavior, dishonesty, sexually aberrant behavior, warrants for arrest, open investigations, or felony charges.
I do so with full knowledge that this information is confidential and as such protected from unauthorized disclosure by the Privacy Act of 1974, as amended.
It is also my understanding that any information provided shall be treated confidentially and be used solely to determine whether I am eligible to access the installation.
***PRIVACY ACT INFORMATION***
PRINT LEGAL NAME:
| SSN: |
| BIRTH DATE: |
SIGNATURE:
US CITIZEN? (Circle One): YES / NO
DATE:
PRIVACY ACT STATEMENT
IAW the Privacy Act of 1974, the contents of this document contain privileged or other confidential information. Unauthorized disclosure may result in civil and criminal sanctions. If you are not the intended recipient, or believe you may have received this communication in error, do not reproduce, retransmit, disseminate, or otherwise use this information.
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File details come from the government source that posted it. Updated .