Background_Check_Authorization.pdf
PDF 2 MB Posted
- Solicitation number
- 2026-ITB-272
- Issued by
- Pierce County, Washington
About this file
This is a Background Check Authorization form issued by Pierce County Facilities Management for use in conjunction with the Facilities Management On-Call General Contractor Services contract opportunity in Washington. The form serves as the initial documentation required for applicants seeking access to Pierce County facilities, including court facilities, general office buildings, and correctional facilities. Applicants must complete this authorization to undergo a criminal history investigation and background verification process as a condition of obtaining badge access or facility clearance for construction and facility modification projects. The form establishes that Pierce County Facilities Management will conduct investigations at either a Moderate or PREA/CJIS background level, depending on the nature of the access required.
The Background Check Authorization form requires applicants to provide comprehensive personal information including full legal name, date of birth, contact details, employment information, and disclosure of any aliases or previous residency outside Washington State. The completed investigation process includes multiple verification checks: fingerprint analysis, Global Name Inquiry, WASIS/NCIC III searches, state-specific DOL records checks, LINX queries, Interpol searches when applicable, and out-of-state background checks. Applicants must certify that all submitted information is true and complete, understanding that false information constitutes grounds for immediate and permanent denial of access. A valid driver's license or state ID card must accompany the submitted form, which is processed by Pierce County Facilities Management with recommendations for clearance or denial issued upon completion of the investigation.
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Text version
Pierce County Facilities Management
930 Tacoma Ave S
Basement Room B44
Tacoma WA 98402
Office (253)798-7301
Department of Facilities Management
Employer (Completed by Applicant)
Requestor (Completed by Department Security Coordinator)
Sheriff’s Department (Completed when applicable by Sheriff's Department Background Investigation Unit)
Background Level
(For use by PCFM Security Date: _____________
Moderate PREA
CJIS
Pierce County Department: _____________________________________________________________________________________
County Requestor/Project Manager: ____________________________________________________
Project/Contract Name: ______________________________ Location of Project/Contract: _________________________________
Requires LENEL ACCESS: YES NO CJIS AREA: YES NO
Applicant Information (Completed by Applicant)
Last Name: ________________________________ First Name: ____________________ MI: ___
Maiden Name: _____________________________ Email Address: _________________________________________ Other Names Used:
Last Name: ________________________________ First Name: ____________________
Last Name: ________________________________ First Name: ____________________
Home Address:_____________________________ City: _______________ State:______
MI: ____
MI: ____
Zip Code: ______________
DOB: ____\ ____ \ ______ Place of Birth (City, St, Country): ____________________________________________________
Race: _________ Sex:__________ Height: _______ Weight: _____ Eye Color: __________ Phone Number:___________________
Alien Registration #: ________________________________________ Social Security#: (Last Four)
Drivers License #: __________________________ State License is Registered: __________________________________________
YESHave you lived in Washington State Continuously over the past 5 years? NO
List all Cities and States you have lived in: _________________________________________________________________________
Company Name: ____________________________________ Employer Phone Number: ___________________________________
Job Title: __________________________________________ Reason for Access: _________________________________________
Completed Initial Unit # Date Cleared/ Denied/NA Fingerprints
Global Name Inquiry (All)
WASIS / NCIC III
Out of State Check (If Applicable)
DOL (Each State)
LINX
LINX NW
Interpol (If Applicable
Review of NCIC Finger Prints Check
Recommendation: Cleared Denied
**Please Attach a Copy of the Applicant’s Valid Drivers License OR State ID Card to Process this Request**
Mail or Deliver Processed and Completed form to:
Background Certification: Because Pierce County Facilities Management strives to provide a Safe and Secure Environment, I understand that Pierce County Facilities Management will order a criminal history check, and I authorize this investigation.
• I certify that all of the information provided on this application is true and complete.
• I understand providing false information is grounds for immediate and potentially permanent denial of a badge/access to County sites.
• I authorize Pierce County Facilities Management / Pierce County Sheriff's Department to investigate and verify any and all information I have submitted.
Signature: _______________________________________________ Date: __________
Authorization (Completed by Applicant)
Revised 01/28/2025
File details come from the government source that posted it. Updated .