GSS26009-MOTOR_OIL-appD.pdf
PDF 190 KB Posted
- Solicitation number
- GSS26009-MOTOR_OIL
- Issued by
- Delaware
About this file
This document is a Security Clearance Application form from the Delaware Department of Correction (DOC), designed for individuals seeking access to correctional facilities. The form is comprehensive and applies to various types of access, including one-time visits, occasional volunteer or service provision (less than 3 days per week or 165 days per year), and frequent/long-term volunteer or service provision (at least 3 days per week or 165 days per year). Applicants must provide detailed personal information, criminal history, and justification for their security clearance request. The form explicitly states that attorneys and employees of DOC's contracted medical/behavioral health providers should not complete this form.
The application requires extensive background information, including personal details, other names used, criminal history, current supervision status, and relationships to incarcerated individuals. Volunteers, interns, and professional service visitors must attach a letter from their sponsoring organization on agency letterhead, signed by the director. The form includes sections for explaining the reason for clearance, type of volunteer or professional services to be provided, qualifications, and past organizational involvement. The final section requires the applicant's signature and understanding that DOC authorities will verify criminal record information, and the application may be rejected for any reason. The last page is reserved for DOC use, documenting DELJIS and NCIC records checks and providing spaces for approval or denial with specific reasons for potential denial.
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Other files
| File | Type | Posted |
|---|---|---|
| GSS26009-MOTOR_OIL-appB.pdf | ||
| GSS26009-MOTOR_OIL-itb.pdf | ||
| GSS26009-MOTOR_OIL-appC1.xlsx | XLSX spreadsheet | |
| GSS26009-MOTOR_OIL-appC2.xlsx | XLSX spreadsheet |
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Text version
SECURITY CLEARANCE APPLICATION
DELA WARE DEPARTMENT OF CORRECTION
PLEASE PRINT CLEARLY
WHO SHOULD COMPLETE THIS FORM:
i. Applicants requesting one-time access or occasional access (whether for one facility or multiple facilities)
ii. Applicants requesting a badge for access to one or more facilities (frequent access for period of 1 year or more) Note: These applicants will be directed to Human Resources after this form is approved
m. Individuals requesting to schedule an offender visit may be asked to complete this form.
Pai:;e 1 of3
Volunteers, interns and professional service visitors must attach a letter from their sponsoring organization. Letter must be on agency letterhead, signed by the agency's director and include the name and title/role of the applicant and the name of the program.
WHO SHOULD NOT COMPLETE THIS FORM:
(1) Attorneys
(2) Employees ofDOC's contracted medical/behavioral health provider (please contact DOC's Human Resources directly)
SECTION 1: PERSONAL INFORMATION & CRIMINAL HISTORY
NAME: _________________________________ _
(LAST) (FIRST) (MIDDLE)
PLEASE LIST ALL OTHER NAMES YOU HA VE USED INCLUDING MAIDEN, NICKNAMES AND RELIGIOUS
NAMES:
DOB: ____ _ PLACE OF BIRTH: ________ _ _ _ SSN#:
SEX: MALE / FEMALE RACE: _____ DRIVER'S LICENSE#: _________ STATE: __ _
ADDRESS:
CITY: _______________ _
PHONE: HOME:<�-�) _______ _
EMAIL:
APT#: ------
STATE: ZIP: ----- -----
WORK:<�--�) _______ _
PLEASE LIST WHICH FACILITY(IES) YOU ARE REQUESTING ACCESS TO:
PLEASE ELECT TYPE OF ACCESS REOUE TED
Offender Visit
_ One Time Access (i.e. single event) * No badge issued _ Occasional Volunteer or Service Provision (Less than 3 days per week or less than 165 days per year for a period of one year or less) * No badge issued _ Frequent/Long Term Volunteer or Service Provision (At least 3 days per week or 165 days per year for a period of one year or more) * You will be directed to HR to fill out a badge application packet after this form has been approved by the respective DOC Bureau Chief
DO YOU HA VE ANY ARRESTS FOR CHARGES OTHER THAN TRAFFIC TICKETS (WHETHER CONVICTED, DISMISSED, NOLLE PROSSED, OR PARDONED)? NO/YES (IF YES, COMPLETE BELOW). IF YOU NEED MORE
ROOM, PLEASE ATTACH A SEPARATE SHEET.
COUNTRY:
DATE: ______ _
OFFENSE: ___________ _
APPENDIX D
Kimberly.Girantino Typewritten Text
Untitled
File details come from the government source that posted it. Updated .