Attachment_8_USMSContractor_Security_clearance_request.pdf

United States Marshals Service

Eastern District of Virginia

CCOONNTTRRAACCTTOORR SSEECCUURRIITTYY CCLLEEAARRAANNCCEE RREEQQUUEESSTT FFOORRMM

Any building tenant scheduling contractor services to be performed inside U.S. Courthouse space must complete this form in its entirety and submit to the local U.S. Marshals Service office a minimum of twenty-four (24) hours in advance of the contractor start date.

GSA / U.S. Courthouse Tenant Contact Information

Requesting Agency:

Requestor (Name):

Office Telephone Number: Mobile Phone:

Contractor / Vendor Information

Full Name (Last, First,Middle): Gender: Male Female

Date of Birth (mm/dd/yyyy): Soc. Sec. Number:

Place of Birth:

Current Home Address:

City: State: Zip Code:

Race:

Company Name:

*Contractor/Vendor must be escorted at all times in non-public areas of the courthouse*

Results of Inquiry

Pass: Fail:

US Courthouse Tenant

/ GSA

Approver Signature:

Attachment 9