Attachment H, Candidate Cover Sheet.pdf

Attachment H, Candidate Cover Sheet

RFO No. HHS0017021 Attachment H

Attachment H, Candidate Cover Sheet

Contract: HHS0017021 – Service Desk and Deskside Support Services

Staffing Request Type:

☐ Transition Staffing ☐ Operations Staff ☐ Replacement / Backfill

1. Candidate Identification

Field Information

Candidate Full Name

Exhibit O Position Title

HHSC Program / Division

Work Location

2. Required Personnel Information (Summary)

This section summarizes required personnel information. Full details must be supported in the attached resume and Exhibit R.

Requirement Response

Years of Relevant Experience

Other Certifications (list)

Meets Exhibit O Minimum Qualifications ☐ Yes ☐ No

Background Check Eligibility ☐ Yes ☐ Pending

Authorized to Work (per contract) ☐ Yes

Requirement Response

Candidate Acknowledgement (Exhibit R attached) ☐ Yes

3. Job Experience Summary

Current / Most Recent Role

• Employer: ______________________________

• Job Title: ______________________________

• Dates of Employment: ____________________

• Resume Experience:

Prior Relevant Role(s)

• Employer: ______________________________

• Job Title: ______________________________

• Dates of Employment: ____________________

• Resume Experience:

• All experience listed above must be fully supported by the attached resume.

• HHSC evaluation will be based on resume content and Exhibit O minimum qualifications.

4. Candidate References

References are provided to support qualification verification and may be contacted by HHSC as part of the selection process.

Reference Name Organization Relationship Phone Email

☐ References available upon request ☐ References attached separately (if applicable)

5. Rate and Availability

Item Details

Proposed Hourly Rate $________ / hour

Pricing Sheet Compliant ☐ Yes ☐ No

Earliest Available Start Date

Interview Availability

6. Resume Validation (Contractor Certification)

☐ Resume submitted is the Original Candidate Resume completed by the candidate ☐ Resume has not been created, modified, or edited by Contractor

Contractor Representative Name: __________________________________________ Signature: __________________________________________

Date: __________________________________________

7. Interview Evaluation Notes (HHSC Use)

A. Interview Panel

Name Role

B. Interview Notes

8. Overall Assessment

Criterion Rating

Technical Fit ☐ Excellent ☐ Good ☐ Fair ☐ Poor

Experience Level ☐ Exceeds ☐ Meets ☐ Does Not Meet

Overall Recommendation ☐ Strong Yes ☐ Yes ☐ Conditional ☐ No

9. HHSC Selection Decision

☐ Approved – Candidate authorized for assignment ☐ Rejected – Additional candidates required

Decision Notes (required for rejection or conditional approval):

HHSC Approving Authority Name: __________________________________________

Title: __________________________________________

Signature: __________________________________________

Date: __________________________________________

If a candidate is approved, the Contractor must complete the section below and submit via email to HHSC in accordance with STF-07.

1. Post Selection Coordination

Item Details

Candidate Name

Offer Acceptance Date

Item Details

Start Date

Email Address

Phone Number

2. Contractor Acceptance & Certification

The contractor hereby certifies acknowledgment of HHSC’S determination regarding the approval of the candidate above for assignment. The contractor further confirms that all necessary candidate information required for staff assignment has been verified and is accurate as submitted.

Contract Representative Name: __________________________ Title: __________________________ Signature: __________________________ Date: __________________________