Attachment C _Background Investigation.docx
DOCX document 44 KB Posted
- Solicitation number
- 36C10D22R0001
- Issued by
-
Department of Veterans Affairs
About this file
This document contains a background investigation request worksheet and related federal contract opportunity solicitation. The background investigation request worksheet is a form used by the Department of Veterans Affairs (VA) to request background investigations on contract employees from the Office of Personnel Management (OPM). It collects applicant information like name, Social Security number, date of birth, and position for OPM to conduct the appropriate level of background investigation, which can be Basic, Moderate, or National Agency Check with Inquiries. The related federal contract opportunity is a request for proposal from the VA for Chapter 31 Vocational Rehabilitation and Employment Services nationwide. Questions regarding the solicitation are due by July 14, 2022 and proposals are due by August 1, 2022. The solicitation seeks these vocational rehabilitation services to support veterans with service-connected disabilities.
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Revised November 2021 VBA Contractor Background Investigation Request Worksheet
ALL FIELDS ON THIS FORM ARE MANDATORY INCLUDING APPLICANT EMAIL
Where Applicant Will Work City, State, Station #
Station to be Billed for Clearance Washington, DC #101
□ New □Transfer □Addition Please provide the following information for each contract employee:
Applicant’s Full Name
First Name, Middle Name (or NMN), Last Name
Social Security Number
Date of Birth Email Place of Birth City, State, Country
Position/Job Title
Does applicant have a clearance pending or completed with OPM?
| □ YES |
| □ NO |
Type of Investigation Requested
| □ BI (High Risk) |
| □ MBI (Moderate Risk) |
| □ NACI (Low Risk) |
Is applicant a foreign national?
| □ YES |
| □NO |
Background Investigation Request Form November 2021
VA Contracting Officer Representative (COR) VA COR Telephone Number COR’s Mail Routing Symbol VA COR Email Address City, State, Zip Prime Contracting Company Name Prime Contracting Company POC POC Telephone POC Email Address City, State, Zip Contract Title Purchase Order Number (Ex: J37243)
SECURITY USE ONLY
SAC: Previous Investigation: Record:
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