Attachment 6C_ Security_SelfCertificationContinuousService.pdf
PDF 102 KB Posted
- Attached to
- Z1DA--NCO5 - MATOC II Federal contract opportunity
- Solicitation number
- 36C24524R0024
About this file
This document is a self-certification form for federal employees or contractors to verify their continuous service with the government. It requires the individual to indicate if they have had a break in service, and if so, the length of that break. If the break in service is greater than 60 days but less than 2 years, the individual must submit an OF 306 Declaration for Federal Employment form. The form is used by the Department of Veterans Affairs Security and Investigations Center to verify the individual's employment history and current investigation status, as well as the risk level of their current position.
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Text version
DEPARTMENT OF VETERANS AFFAIRS
SECURITY AND INVESTIGATIONS CENTER
Self Certification of Continuous Service
I hereby certify my break in service from my last federal employment is indicated by the block checked below.
I have NOT had a break in service.
My break in service was less than 60 days.
My break in service was greater than 60 days, but less than 2 years. (You are required to submit the OF 306, Declaration for
Federal Employment, with this form.)
My break in service is greater than 2 years or; I have never had employment through the federal government.
Print Name: Social Security Number:
Signature: Date:
VA Personnel Security/HR Use Only:
Current Investigation in PIPS: Date:
Risk level of current position: Verified by:
(Check One)
Federal employment is defined as any branch of the United States military (Active, Guard or Reserve), federal government civilian employee (any federal government agency), or a contractor working for the federal government.
Self Certification of Continuous Service Form Revised February 14, 2017
Previous Versions are Obsolete
| I have NOT had a break in service: Off |
| My break in service was less than 60 days: Off |
| My break in service was greater than 60 days but less than 2: Off |
| My break in service is greater than 2 years or I have never worked: Off |
| Print Name: |
| Social Security Number: |
| Date: |
| Current Investigation in PIPS: |
| Date_2: |
| Risk level of current position: |
| Verified by: |
File details come from the government source that posted it. Updated .