ECSD Authority for release of information~10.pdf

246 KB Posted

Attached to
Furnish and install our Detention Surface Padding System
Solicitation number
BD-24-1401-ECSD1-ECSD1-91244
Issued by
Essex County, Massachusetts

About this file

Written by GovTribe AI ·

This document is a Background Information Request and Waiver form from the Essex County Sheriff's Department. The form requests personal information, including name, address, social security number, driver's license, date of birth, and other details, to allow the Sheriff's Department to conduct a background investigation. The investigation may include checks with past employers, local and state police departments, the FBI, and other agencies as deemed necessary by the Department.

The related state and local contract opportunity is for the Furnish and Install of a Detention Surface Padding System, located in the state of Massachusetts. No other details about the specific contract requirements, response dates, award information, or contract term are provided in the given information.

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Other files

File Type Posted
ECSD PREA Form~12.pdf PDF
Scope of Work~3.docx DOCX document
Q and A - Padded Walls.docx DOCX document
Prevailing Wage~4.pdf PDF

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BACKGROUND INFORMATION REQUEST AND WAIVER

(PLEASE PRINT CLEARLY OR TYPE)

NAME

LAST FIRST MIDDLE

PREVIOUS NAME AND/OR ALIAS

RESIDENTIAL ADDRESS

(Not a P.O. Box) NUMBER STREET CITY STATE ZIP

HAVE YOU EVER RESIDED IN ANOTHER STATE? IF YES, WHICH STATE(S)

SOCIAL SECURITY NUMBER

DRIVER’S LICENSE NUMBER STATE

DATE OF BIRTH PLACE OF BIRTH

SEX RACE Contact Number

MOTHER’S MAIDEN NAME

FATHER’S NAME

I, , hereby release, discharge, and exonerate the Essex County Sheriff’s Department, its agents and representatives, and any person so furnishing information, for any and all liability of every nature and kind arising out of furnishing or inspection of such documents, records and other information or the investigations made by or on behalf of the Essex County Sheriff’s Department.

I further understand that the Essex County Sheriff’s Department will conduct a background investigation which may include a check with past employers, a criminal records check with the lo cal police department, the State Police, the FBI in Washington, D.C. the Massachusetts Board of Probation and Registry of Motor

Vehicles. The Essex County Sheriff’s Department will conduct these checks as the Department deems necessary.

Witness Signature

PREVIOUS NAME ANDOR ALIAS:
RESIDENTIAL ADDRESS:
HAVE YOU EVER RESIDED IN ANOTHER STATE:
IF YES WHICH STATES:
SOCIAL SECURITY NUMBER:
DRIVERS LICENSE NUMBER STATE:
DATE OF BIRTH:
PLACE OF BIRTH:
SEX:
RACE:
MOTHERS MAIDEN NAME:
FATHERS NAME:
I:
Last NAME:
First Name:
Middle:
Contact Number:

File details come from the government source that posted it. Updated .