CONTRACTOR_PRE-EMPLOYMENT_FORM.docx

DOCX document 14 KB Posted

Attached to
Installation of Systems, Case Goods, Seating and Accessories Federal contract opportunity
Solicitation number
FN1406-15
Issued by
Department of Justice Bureau of Prisons

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Contract Pre Employement Form

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Text version

CONTRACTOR PRE-EMPLOYMENT FORM

NAME: ___________________________________________________

ADDRESS: ___________________________________________________

SOCIAL SECURITY NUMBER: _________________________________

Do you know or are you related to anyone who is currently an inmate in this or any other correctional institution? ___Yes ___No

If yes, please provide names, locations, relationships and describe any current or anticipated contact with the inmate(s).

Are there any criminal charges currently pending against you? ___Yes ___No

If so, please provide charge, date arrested, court dates, docket numbers and any other pertinent details.

Are you now or have you ever been incarcerated or under correctional supervision (including home detention, probation, work release, etc.)? ___Yes ___No

If so, please provide dates of incarceration, sentence, location, charges, current status and any other pertinent details.

CERTIFICATION--I certify that all of the statements made on these pages are true, complete and correct to the best of my knowledge and belief and are made in good faith.

_______________________________________________________________________
SignatureDate

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