Attachment 2(G) - CSO Form 009.pdf

CSO FORM 009 (EST. 04/06)

Section J - Attachment 2(G)

NOTIFICATION OF A COURT SECURITY OFFICER����S

OFFICIAL PERFORMANCE DATE

DATE MONTH

DATE

YEAR

NAME

STREET ADDRESS

CITY

STATE

ZIP CODE

CONTRACTOR����S

INFORMATION

TELEPHONE NO.

CSO����S NAME

LAST NAME

FIRST NAME

MIDDLE NAME

SOCIAL SECURITY NO.

DISTRICT ASSIGNMENT

DISTRICT NO.

STREET ADDRESS

FACILITY LOCATION

CITY

STATE

ZIP CODE

PERMANENT STATUS

TEMPORARY STATUS (MILITARY)

CSO����S STATUS

(Check the applicable box.)

����� FULL-TIME � SHARED

� SHARED

� FULL-TIME

� SHARED

SUITABILITY

DETERMINATION DATE

MONTH

INITIAL WEAPON

QUALIFICATION DATE

IN-DISTRICT

ORIENTATION DATE

OFFICIAL PERFORMANCE

I hereby certify that the above information is true and accurate.

I hereby certify that the individual stated above has fulfilled the In-District Orientation and the weapons proficiency test requirements.

Court Security Officer����s Name (Print)

Contractor����s Supervisory Representative Name (Print)

Court Security Officer����s Signature

Contractor����s Supervisory Representative Signature

Date

Date

INSTRUCTIONS TO THE CONTRACTOR: Retain a copy of this form for your records and forward the original to the United States Marshals Service, Judicial Security Division, Judicial Protective Services, Attention: Personnel Support Branch, Washington, DC 20530-1000, within 5 business days after the individual�s official performance date.