Attachment 2(C) - CSO Form 005.pdf

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Form CSO-005 Rev. 03/13 Page of U.S. Department of Justice United States Marshals Service Court Security Officer Preliminary Background Check Form

INSTRUCTIONS FOR CONTRACTING COMPANY TO COMPLETE THIS FORM

This form must be used and completed by the contractor only, unless otherwise noted, to conduct preliminary background checks on those individuals proposed to perform on your company's behalf under the United States Marshals Service's contract for court security services. Incomplete forms or illegible forms will be considered unacceptable and will be returned. This form must be submitted in accordance with the time requirements stated in the applicable United State Marshals Service's contract.

PART I

PART II

4. Preferred Title (Check one):

6. Social Security Number:

9. Is the applicant a citizen of the United States of America?

If Naturalization citizen:

10. Did the applicant graduate from high school or have a GED high school equivalency?

If 'Yes', answer questions below:

11. Can the applicant read, write and speak the English language?

12. Does the applicant have a current U.S. driver's license?

12b. If yes, has the applicant maintained a safe driving record for the past five (5) years?

12c. If no, can the applicant obtain a valid U.S. driver's license?

13. Did the applicant complete or graduate from a certified federal, state, county, local or military law enforcement training academy or program that provided instruction on the use of police powers in an armed capacity while dealing with the public?

ARREST AUTHORITY VERTIFICATION: You must verify the applicant's arrest authority and obtain a copy of the applicant's training certificate or diploma prior to submitting the applicant's package to the United States Marshals Service. If the applicant did not receive a training certificate or diploma, a letter from the training department or agency may suffice. This letter must indicate that the applicant was employed as a law enforcement officer and that the department or agency did not or does not issue certificates or diplomas upon completion of such training.

PART III

LAW ENFORCEMENT EXPERIENCE VERIFICATION: Applicants are required to have at least 3 total years of law enforcement experience within the past 7 years. You must verify the applicant's law enforcement experience with the applicant's previous employer(s). List experience below, starting with most recent. If additional space is required, use continuation page.

Employment #1

7. Retired?

8. If possible, would the employer rehire the applicant?

9. Which representative of this organization verified the applicant's law enforcement employment history?

Employment #2

7. Retired?

8. If possible, would the employer rehire the applicant?

9. Which representative of this organization verified the applicant's law enforcement employment history?

PART IV

1. APPLICANT'S SIGNATURE, CERTIFICATION, AND RELEASE OF INFORMATION

I have the knowledge and understanding that any or all items contained herein may be subject to investigation and I consent to the release of information concerning my capacity and fitness by employers, educational institutions, law enforcement agencies, and other individuals and agencies, and other authorized employees of my potential employer, who is under contract with the Federal Government (United States Marshals Services) for that purpose.

CERTIFICATION: I certify that all of the statements are true, complete, and correct to the best of my knowledge and belief, and are made in good faith.

2. CONTRACTOR'S SIGNATURE AND CERTIFICATION STATEMENT

I hereby certify that I have been authorized by my employer, to conduct a complete and thorough preliminary background check on the subject applicant, whom my employer is seeking to hire, and/or provide as a qualified candidate for a CSO position. I also certify that the findings resulting from the preliminary background check have been stated in a true, complete, and accurate manner.

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