DOJ Residency Form.pdf

Department of Justice Residency Requirement Certification Form

The residency requirement certification must be completed and returned with the offer/bid/quote for individuals applying for a contract. Companies must submit a completed certification for each of their employees performing work, prior to performance. In order to facilitate the clearance process, companies should submit the certifications as soon as it is apparent which employees will be performing the work but no later than one week prior to performance. Documentation to substantiate residency may be requested at any time prior to award for contracts with individuals and prior to performance for awards to other than individuals.

I certify that for three of the five years immediately prior to responding to this solicitation, I have: 1) resided in the United States (U.S.); 2) worked for the U.S. overseas in a Federal or military capacity; or 3) have been a dependent of a Federal or military employee serving overseas.

Name of Vendor/Individual Date

Signature of Individual