4._Appendix_D__Required_Reports_and_Form.pdf

RFP#: FA520920R0001

APPENDIX D – Required Reports and Forms

APPENDIX D - Required Reports/Forms

Required Due Date Written Proof of Records Check Pre-Performance Conference Cleaning Frequency Schedules (Monthly/Annual) Upon Contract Award Primary/Alternate Contract/Project Managers Upon Contract Award AF Form 3000 – Material Approval Submittal Upon Contract Award / As Needed Customer Complaint Form As Needed Employee Statement Form Upon Contract Award / As Needed

RFP#: FA520920R0001

APPENDIX D – Required Reports and Forms

Employee Statement Form

In accordance with AFI 34-248, this form is to be completed by any employee who will be assigned independent work at the Youth Center, Teen Center, Child Development Center or any facility concerning children. Completed copies will be provided to the Contracting Officer.

1. Have you ever been arrested or convicted of a crime involving a child?

_______ Yes _______ No

If yes, describe the disposition of the arrest or charge.

2. Have you ever been arrested or convicted of a crime involving substance abuse.

_______ Yes _______ No

If yes, describe the disposition of the arrest or charge.

3. Have you ever been arrested or convicted of a crime involving a sex crime or violent crime.

_______ Yes _______ No

If yes, describe the disposition of the arrest or charge.

Your signature certifies that the above statements are true, correct, complete, and made in good faith.

NAME

SIGNATURE DATE