Attachment_J_18_-_SECURITY_FORMS.pdf

Security Forms Attachment J.18

DISTRICT OF COLUMBIA COURTS

SECURITY CLEARANCE FORM

COMPANY NAME:

PROJECT MANAGER:

EMPLOYEE NAME

DATE OF BIRTH

SOCIAL SECURITY NUMBER

STATE

DRIVER’S LICENSE NUMBER

WORKSITE:

JOB DESCRIPTION:

Date of Request: (Numbers Only) Metropolitan Police Department

Washington, D.C

Criminal History Request

Social Security Number: (Numbers Only)

Request Record of: (Last, First, Middle Name) Purpose of Request:

Law Enforcement (non-employment)

Visas*

Employment/ Licensing*

Challenge*

Address:

Sex:

Male Race: Birthdate: (Numbers Only) Place of Birth:

Requesting Agency:

District of Columbia Courts

Call-Back Number:

(202) 879-0496

Signature of Agent: Badge No.: Method of Request:

Mail

In Person

NLET

Telephone

IDENTIFICATION AND RECORDS DIVISION USE ONLY - (Check if applicable)

SUBJECT UNDER ARREST CORRECT COLOR CODE

Request Received By: Date and Time Received: Date and Time Returned:

D.C. Code § 6-2276 IS QUOTED HERE FOR YOUR INFORMATION

It shall be an unlawful practice, punishable by a fine of not more than three-hundred dollars ($300), or imprisonment for not more than ten (10) days, or both, for any person to require the production of and arrest record or any copy, extract, or statement thereof, at the monetary expense of any individual to whom such record may relate. Such "arrest records" shall contain only listings of convictions and forfeitures of collateral that have occurred within ten (10) years of the time at which such record is requested. (Dec. 13, 1977, D.C. Law 2-38, Title II, § 266, 24 DCR 6038).

*I hereby authorize the release of my adult arrest record revealing convictions and forfeitures within the past ten (10) years.

Signature Date

RESULTS OF CRIMINAL HISTORY FILE SEARCH

Name Search Fingerprint Search TO: Criminal History Users

This request concerns information whose collection, dissemination, and use are conditioned and restricted by applicable federal and District of

Columbia statutes, and policy of the Metropolitan Police Department. Continued assistance from this department is conditioned upon your strict adherence to these regulations.

WARNING TO APPLYING AGENCIES: The Metropolitan Police Department does not guarantee either the accuracy of the record or that the individual whose record is furnished is actually the same individual whose record was requested. To obtain accuracy, the record of the Court involved should be examined. Positive identification can only be determined by comparable fingerprints. Records of arrests obtained from the

Metropolitan Police Department as detailed on this form are for convictions and forfeitures for the past 10 years prior to the date of request of this record, exclusive of periods of imprisonment, if any. This record does not reflect any cases which may be currently pending before the Courts or cases where convictions have been set aside pending appeals.

CHIEF OF POLICE

Date of Arrest Charge(s) Disposition

Documents Released:

Criminal History Record Photograph Other:

Prosecution Report Fingerprints Other:

Date of Record Search:

Record Searched By:

Release Authorization:

SECURE ACCESS

REQUEST FORM

Name of Contractor/Vendor:

Secure Area Requiring Access:

Date of Work:

The following task(s) will be performed:

TASK (S):

The following contact is giving authorization / permission to enter the secure area on the above date:

Signature Date

NOTE: Your area will be protected from dirt and dust, and will be cleaned by the contractor. Any furniture moved will be returned to its proper place. All Chambers require the presence of the Courts Security Officer or Administrative Service Personnel, during the scheduled task(s). The designated individual will remain with the contractor while work is in progress.

[If Required] Signature of Court Security Officer upon completion of above Date Time referenced work:

Signature of Project Manager that above area task (s) was completed Date Time and area was cleaned.

CAMERA LETTER REQUEST FORM

Contracting Company:

Contractor Contact Name:

Address:

Phone Number:

The above listed Contractor is requesting approval to take photographs within the construction areas of the following project:

Project Name:

The Contractor understands that in order to take photographs within the DC Court buildings a “Camera Letter” must be issued to the Contractor and a copy of this letter must be carried at all times by any member of the Contractor’s staff that will be taking photographs. The Contractor understands that no photographs of any person will be taken in or around any DC Court buildings.

Please return this completed form to Project Manager.