(Attachment 4) PSIR_MN1998-E.PDF

1 MB Posted

Attached to
Oregon National Guard Case Management Services
Solicitation number
W912JV23Q0021
Issued by

About this file

Written by GovTribe AI ·

This document appears to be a template for submitting personnel security investigation requests for National Guard positions. It requests information such as name, birthdate, citizenship, phone numbers, email addresses, military grade, position sensitivity level, and clearance requirements. The related federal contract opportunity is solicitation number W912JV23Q0021 from the Department of the Army Oregon Army National Guard for case management services. It does not provide many additional details on the required products or services.

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MM/DD

(MM/DD/YYYY) BREAK IN SERVICE DATES: TO

nubiafaith

Typewritten Text nubiafaith Typewritten Text nubiafaith Typewritten Text nubiafaith Typewritten Text nubiafaith Typewritten Text

DATE ELECTRONICALLY SUBMITTED TO OPM:

nubiafaith Typewritten Text

HARD COPY ON HAND TO MAIL ONCE PSI REQUEST IS INTIATED?

nubiafaith Typewritten Text

FINGERPRINT CARD MAILING ADDRESS:

PSI-CoE Attn: Fingerprint Team 3240 Raritan Avenue Aberdeen Proving Ground, MD 21005 nubiafaith Typewritten Text

OR

nubiafaith Typewritten Text nubiafaith Typewritten Text nubiafaith Typewritten Text

FINGERPRINT CARDS SUBMISSION METHOD:

nubiafaith Typewritten Text nubiafaith Typewritten Text Refer to MN NG PERSEC SOP for fingerprint card requirements.

nubiafaith Typewritten Text nubiafaith Typewritten Text erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight erin.quirke Highlight rudolph.r.figueroa Highlight rudolph.r.figueroa Highlight

TECHNICIAN POSITION SENSITIVITY LEVELS

FORM COMPLETION INSTRUCTIONS

Cross-Out

SSN:
MILITARY:
CIVILIAN:
CONTRACTOR: On
LAST NAME:
FIRST:
MIDDLE:
salutation:
COUNTRY OF BIRTH:
CITY OF BIRTH:
US CITIZEN:
UNITORGANIZATIONCOMPANY:
PRIMARY EMAIL AKO RECOMMENDED:
ALTERNATE EMAIL:
MOS CODE MILITARY ONLY eg 96B:
undefined_2:
POSITION DESCRIPTION PD CIVILIAN ONLY ATTACH COPY:
undefined_3:
OTHER PROVIDE SPECIFIC DETAILS OF THE REQUIREMENTRow2:
SELECT DOCUMENT LIST: [SELECT FROM LIST]
PRIMARY PHONE LIST: [SELECT]
ALTERNATE PHONE LIST: [SELECT]
PERIODIC REINVESTIGATION: [SELECT FROM LIST]
POSITION SENSITIVITY: [SELECT FROM LIST]
CLEARANCE/INVESTIGATION REQUIRED: [SELECT FROM LIST]
OTHER PROVIDE SPECIFIC DETAILS OF THE REQUIREMENTRow1:
OTHER PROVIDE SPECIFIC DETAILS OF THE REQUIREMENTRow 0:
EMAIL:
ORGANIZATION:
STATE OF BIRTH:
FINGERPRINT DATE:
SUFFIX: [SELECT]
NAME OF COMMANDER/SUPERVISOR:
INTERIM REQ: [SELECT]
FPC SENT: [ELECTRONIC]
PHONE NUMBER:
OTHER PROVIDE SPECIFIC DETAILS OF THE REQUIREMENT:
BIRTH DATE:
CERTIFY JUSTIFICATION:
PRIMARY PHONE NUMBER:
ALT PHONE NUMBER:
DATE AKNOWLEDGED:
ETS DATE:
BREAK IN SERV FROM:
BREAK IN SERV TO:
Check Box2: Off
soldier GRADE:
sec mgr GRADE:

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