Attachment 2 - Recruitment USMS-606.pdf

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Form USM-606 Est. [TBD] Page of

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Form USM-606 Est. [TBD] Page of Protective Services Officers (PSO) Affirmation of Work Qualifications (continued)

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Note: Completed forms containing personally identifiable information (PII) must be encrypted and include the appropriate marking (U/FOUO) in the SUBJECT line of the message prior to dissemination via email.

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U.S. Department of Justice United States Marshals Service Protective Services Officers (PSO) Affirmation of Work Qualifications INSTRUCTIONS: This form is used to document the necessary criteria for an individual to enter into a personal services contract as a PSO with the United States Marshals Service (USMS). Duties will include providing protective services in support of USMS Districts and the Judicial Security Division (JSD). Sections I and II are completed by the applicant's immediate supervisor. Section III must be completed by the applicant. Return the completed affirmation to the USMS Contracting Officer, Contracting Officer's Representative, or designee to continue the contracting process.

SECTION I - SUPERVISOR CRITERIA CERTIFICATION (To be completed by applicant's supervisor)

1. Applicant is a full-time actively sworn law enforcement officer.

2. Applicant meets employer physical/mental fitness standards.

3. Applicant is free of employer Internal Investigation.

4. Applicant is free of misdemeanor conviction for crimes of domestic violence (Lautenberg Amendment).

5. Applicant is not the subject of a restraining order.

6. Applicant is approved by his/her employer for outside work.

7. If reserve officer: Applicant has at least one year or 2,087 hours of law enforcement experience.

SECTION II - TRAINING CRITERIA CERTIFICATION (To be completed by applicant's supervisor)

1. The employer has trained and qualified the applicant with his/her duty weapon in the past 12 months.

2. The employer has trained and qualified the applicant to carry and use a Projectile Stun Gun (PSG).

3. The employer has trained and qualified the applicant to carry Oleoresin Capsicum Aerosols (OC spray).

4. The employer has trained and qualified the applicant to carry an expandable baton.

5. The employer has trained the applicant in handcuffing and prisoner searching procedures and techniques.

6. The employer has trained the applicant in bloodborne/airborne pathogens.

CERTIFICATION: This affirmation and any attachments to it, are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that a knowing and willful false statement on this affirmation can be punished by fine or imprisonment or both. (See Title 18, United States Code Section 1001) SECTION III - APPLICANT CRITERIA CERTIFICATION (To be completed by applicant)

1. I am a United States citizen.

2. I have reached my twenty-first (21st) birth date.

3. I am able to speak and write in the English language.

4. I possess a valid driver's license from my current state of residence.

5. I have no felony criminal convictions, disqualifying misdemeanor or convictions, or derogatory civil records (Lautenberg Amendment). Disqualifying events will be determined by the Contracting Officer's Representative.

6. I am current with debt payments, or in a debt repayment plan for those that are past due.

7. I am not the subject of any restraining orders.

8. I am physically able to perform the full range of duties without limitations as described in the Statement of Work (SOW).

9. I am free of illegal drug use.

10. I have a high school diploma or GED equivalent.

CERTIFICATION: This affirmation and any attachments to it, are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that a knowing and willful false statement on this affirmation can be punished by fine or imprisonment or both. (See Title 18, United States Code Section 1001)

AUTHORITY TO REQUEST THIS INFORMATION

The authority for collection of this information is 5 U.S.C. 3301 and 28 U.S.C. 561. The USMS needs the information requested in this form to evaluate your qualifications to perform the duties of a PSO with respect to providing protective services in support of USMS Districts and the Judicial Security Division (JSD).

PRIVACY ACT OF 1974 COMPLIANCE INFORMATION

Providing the information on this form is voluntary, however, failure to furnish the requested information may delay or prevent action on your employment as a PSO. In addition, incomplete, misleading, or untruthful information provided on the form may result in delays in processing the form for employment, termination of employment, or criminal sanction. The last four digits of your Social Security number are needed because other people may have the same name and birth date. Executive Order 9397 authorizes Federal agencies to use this number to help identify individuals in agency records.

PRIVACY ACT ROUTINE USES

This form or information contained therein may be disclosed in accordance with the routine disclosures set forth in the Office of Personnel Management government-wide system of records, OPM/Govt-1, General Personnel Records, 76 Fed.Reg. 32997 (June 7, 2011), including but not limited to:

1. The disclosure of pertinent information to the appropriate Federal, State, or local agency responsible for investigating, prosecuting, enforcing, or implementing a statute, rule, regulation, or order, when the disclosing agency becomes aware of an indication of a violation or potential violation of civil or criminal law or regulation.

2. The disclosure of information to any source from which additional information is requested (to the extent necessary to identify the individual, inform the source of the purpose(s) of the request, and to identify the type of information requested), when necessary to obtain information relevant to an agency decision to hire or retain an employee, issue a security clearance, conduct a security or suitability investigation of an individual, classify jobs, let a contract, or issue a license, grant, or other benefits.

3. The disclosure to a Federal agency in the executive, legislative, or judicial branch of Government, in response to its request, or at the initiation of the agency maintaining the records, information in connection with the hiring of an employee, the issuance of a security clearance or determination concerning eligibility to hold a sensitive position, the conducting of an investigation for purposes of a credentialing, national security, fitness, or suitability adjudication concerning an individual, the classifying or designation of jobs, the letting of a contract, the issuance of a license, grant, or other benefit by the requesting agency, or the lawful statutory, administrative, or investigative purpose of the agency to the extent that the information is relevant and necessary to the requesting agency's decision.

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