Attachment J-2 CSOSA Credit Release Form - V1 - 1-19-21.pdf

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Attached to
Psychotherapy Group Services
Solicitation number
9594CS24Q0025
Issued by

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This document is a credit release form from the Court Services and Offender Supervision Agency (CSOSA) that authorizes CSOSA to obtain consumer and credit reports about an individual for employment purposes, including evaluating fitness for employment, promotion, reassignment, retention, or access to classified information.

The related federal contract opportunity is for CSOSA to acquire psychotherapy group services. CSOSA requires a contractor to provide facilitated group psychotherapy and individual psychotherapy sessions for residents at CSOSA's Re-Entry and Sanction Center. The contractor must be available to provide on-site or virtual group and individual therapy sessions for a minimum of 60 minutes per session, during the hours of 9:00 am - 9:00 pm Monday to Friday. The solicitation number is 9594CS24Q0025.

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Other files

File Type Posted
Amendment 0001 9594CS24Q0025 Q and As.pdf PDF
Attachment J-1 CSOSA SEC 0010-Temp-Contractor-Form.pdf PDF
9594CS24Q0025 RFQ for Psychotherapy Group Services.pdf PDF
Attachment J-3 PIV Request Form - V1 - 1-19-21.pdf PDF
Attachment J-5 Pricing Worksheet.docx DOCX document
Attachment J-6 - FAR 52.212-3 JAN 2021 - V1 - 1-28-21.docx DOCX document
Attachment J-4 Cover Letter.pdf PDF

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Attachment J-3

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

Court Services and Offender Supervision Agency

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