Attachment J-11 CSOSA Credit Release.pdf

208 KB Posted

Attached to
Medically Managed Intensive Inpatient Withdrawal Management Services
Solicitation number
9594CS26Q0004
Issued by

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This is an employment authorization form for consumer/credit reporting issued by the Court Services and Offender Supervision Agency for the District of Columbia. The document is a template memorandum (Form CSOSA-SEC-0008, Revision 11/2002) that authorizes CSOSA to obtain one or more consumer or credit reports about an applicant or employee for employment-related purposes.

The form specifies that reports may be obtained to evaluate fitness for employment, promotion, reassignment, retention, or access to classified information. The template requires the individual to provide their name, signature, date, and Social Security number to authorize CSOSA to request such report(s) from any consumer/credit reporting agency. The form includes functional buttons for printing, saving, and resetting the document and serves as Attachment J-11 in CSOSA employment documentation.

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Other files

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Amendment 0001 9594CS26Q0004.pdf PDF
Attachment J-2 Billing Authorization.pdf PDF
Attachment J-16 Past Performance Questionnaire.docx DOCX document
Solicitation 9594CS26Q0004.pdf PDF
Attachment J-3 Release of Information- Substance Abuse Treatment.pdf PDF
Attachment J-4 Release of Information - Health Records.pdf PDF
Attachment J-6 Privacy Act Waiver.pdf PDF
Attachment J-9 CSOSA Contact Form.pdf PDF
Attachment J-13 Contractor Confidentiality and Nondisclosure Agreement.docx DOCX document
Attachment J-17 Solicitation Price Sheet.docx DOCX document
Attachment J-1 SOW.pdf PDF
Attachment J-5 Release of Mental Health-Sex Offender Information.pdf PDF
Attachment J-7 Monthly Program Activity Report.pdf PDF
Attachment J-8 CSOSA Treatment Monthly Invoice.pdf PDF
Attachment J-10 Security form for Temp Contractors.pdf PDF
Attachment J-12 WD 2015-4281 Rev 35.pdf PDF
Attachment J-15 Cover Letter.docx DOCX document
Attachment J-14 FAR 52.212-3 Offeror Reps & Certs.docx DOCX document
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Court Services and Offender Supervision Agency for the District of Columbia

MEMORANDUM

This is a release for the Court Services and Offender Supervision Agency to obtain one or more consumer/credit reports about you in connection with your application for employment or in the course of your employment with the Court Services and Offender Supervision Agency. One or more reports about you may be obtained for employment purposes, including evaluating your fitness for employment, promotion, reassignment, retention, or access to classified information.

I,______________________________________, hereby authorize the Court Services and

Offender Supervision Agency to obtain such report(s) from any consumer/credit reporting agency for employment purposes.

Signature

Date

Social Security Number

CSOSA-SEC-0008 Revision: 11/2002

Attachment J-11

txt_name:
txt_date:
txt_ssn:
btn_reset:
btn_print:
btn_save:

File details come from the government source that posted it. Updated .