Background_Check_Form.pdf
PDF 2 MB Posted
- Attached to
- Countywide Generator Maintenance and Repairs
- Solicitation number
- 2026-ITB-185
- Issued by
- Pierce County, Washington
About this file
This is a Background Check Form used by Pierce County Facilities Management in Washington to process security clearances for personnel requiring access to county facilities and systems. The form is completed by applicants seeking access to county sites and is processed through the Pierce County Department of Facilities Management, with involvement from the Pierce County Sheriff's Department Background Investigation Unit when applicable. The form captures applicant demographics, employment information, project or contract assignment details, and authorization for background investigation.
The background check process includes multiple verification steps including fingerprint checks, Global Name Inquiry, Washington State Information System (WASIS) and National Crime Information Center (NCIC III) queries, out-of-state checks through Department of License (DOL) records, LINX database reviews, and Interpol checks when applicable. Applicants must authorize Pierce County Facilities Management and the Sheriff's Department to conduct criminal history investigations and verify all submitted information, with false information grounds for immediate and permanent denial of badge access or site entry. The form requires attachment of a valid driver's license or state ID card and must be signed and dated by the applicant before submission to Pierce County Facilities Management at the specified address in Tacoma, Washington. The form was last revised on January 28, 2025.
View the file
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| Bid_Packet.pdf | ||
| (23)_CJIS_.pdf | ||
| CJIS_Fingerprinting_for_Contractors.pdf | ||
| (21)_Jail_Entry_Packet_with_Guidelines_-_Project_Version_7-23-24.pdf | ||
| Hot_Work_Procedure.pdf |
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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 .