Attachment 08 - PIV Badge Template.pdf
PDF 293 KB Posted
- Solicitation number
- 36C24124R0027
About this file
This document contains a badge template for the Department of Veterans Affairs VA Maine Healthcare System Police Department. The template provides fields for collecting an individual's name, physical address, social security number, gender, service line or company, phone number, date of birth, place of birth, occupation, title, and personal email. It also includes sections for the police department to record results of background checks through the VISTA, VAPS, and local records systems and note the status and date.
The related federal contract opportunity is solicitation number 36C24124R0027 for structural repairs and improvements to support buildings for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 1. The solicitation involves conducting repairs and improvements to support buildings but provides no further details on required products or services, response dates, or other contractual terms.
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Text version
Project Name: Type of Badge Requested: PIV NON-PIV FLASH
Circle one
Departmentof Veterans Affairs
VA Maine Healthcare System
Police Department
1 VA Center 07B
Augusta, ME 04330
207 623-5796
Last Name First Name Middle
Physical Street Address City State and Zip Code
Social Security Number
Gender (M) (F)
Service Line or Company Name Company or Cell Phone Number
Date of Birth
Place of Birth Occupation Title
Personal email for activation of badge process
For Engineers to fill out:
Contract end date:
Service Line Official Date
All highlighted info must be submitted, or a badge cannot be issued
FOR TOG US POLICE USE ONLY
VISTA RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
VAPS RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
LOCAL RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
STATUS F YES NO ADVANCED TO HR
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File details come from the government source that posted it. Updated .