EVT0010348_Background_Check_Form.xls
XLS spreadsheet 39 KB Posted
- Attached to
- Pest Control at Norton Correctional Facility State and local contract opportunity
- Solicitation number
- EVT0010348
- Issued by
- Morris County, Kansas
About this file
This is a background check form issued by the Kansas Department of Corrections for individuals seeking employment, contract work, volunteering, or facility access. The document requires submission of detailed personal information by June 18, 2025, at 2:00 PM CST to Lara J. Williams via email at lara.j.williams@ks.gov. The form is designed to conduct a comprehensive criminal history and information check for potential facility entrants.
The background check form requests extensive personal details including full name, other names used, current address, driver's license information, date of birth, social security number, sex, race, and contact telephone number. The form includes sections for administrative processing, with designated areas for record verification by terminal operators, chief security personnel, and facility wardens. The document appears to be a standard screening protocol (version N-176, revised 4/15/19) to ensure safety and security for the Kansas Department of Corrections facility by thoroughly vetting individuals seeking access.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| EVT0010348_Bid_Documents.pdf | ||
| Pest_Control_at_Norton_Correctional_Facility.pdf | ||
| EVT0010348_Q_A_Pest_Control_at_Norton.pdf | ||
| EVT0010348_Amendment_Three.pdf | ||
| EVT0010348_Amendment_Two.pdf |
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Text version
Sheet1
| KANSAS DEPARTMENT OF CORRECTIONS BACKGROUND CHECK | |||||||||
| Conditions for employment or admittance to the facility for business or volunteer purposes requires a criminal history and information check be completed. Please provide the following information to assist in this process by June 18, 2025, 2:00PM CST to lara.j.williams@ks.gov | |||||||||
| Employee | o | Contract Department | |||||||
| (if applicable) | |||||||||
| Volunteer | o | Affiliation Name | |||||||
| Vendor | o | Company Name | |||||||
| Contractor | o | Company Name | |||||||
| Other | o | (Please Explain) | |||||||
| Reason for Visiting the Facility: | |||||||||
| 1. | Name: | ||||||||
| Last | First | MI | |||||||
| 2. | Other Names Used: | ||||||||
| 3. | Current Address: | ||||||||
| Street | City | State | Zip | ||||||
| 4. | Drivers License No: | State: | Number: | ||||||
| 5. | Date of Birth: | ||||||||
| Month | Day | Year | |||||||
| 6. | Soc. Security No.: | - | - | ||||||
| 7. | Sex: | M | F | ||||||
| (Circle One) | |||||||||
| 8. | Race: | ||||||||
| 9. | Telephone number you can be reached at during the hours of 8:00 a.m. and 4:00 p.m. | ||||||||
| ( ) | |||||||||
| Request Submitted By: | |||||||||
| +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ | |||||||||
| No Record Found | |||||||||
| Record Found (Attach Copy) | |||||||||
| Terminal Operator | Date | ||||||||
| Chief Security (or designee) | |||||||||
| Warden (or designee) | |||||||||
| N-176 | N-174 - Revised 4/15/19 |
File details come from the government source that posted it. Updated .