CBP Contractor Employee Sep Clear Form-242.pdf

CONTRACTOR EMPLOYEE SEPARATION CLEARANCE

Directive 51715-006

All departing Bureau of Customs and Border Protection contractor employees shall complete this form and forward it to their contractor Project Manager or CBP Point of Contact prior to departure. Executive Order 9397 authorizes disclosure of the contractor employee's Social Security Number on this form. Furnishing the Social Security Number is mandatory.

PART I - TO BE COMPLETED BY THE SEPARATING CONTRACTOR EMPLOYEE

1. Contractor Employee's Name 2. Social Security Number

3. Contractor's Company Name and Address 4. Contract/Order Number

5. Reason for Leaving

I certify to the best of my knowledge that I have returned all government furnished property and information.

6. Departure Date 7. Departing Employee Signature 8. Project Manager/Supervisors Signature 9. Date of Signature

PART II - TO BE COMPLETED BY THE CBP POINT OF CONTACT (CBP/POC)

10. Point of Contact Name 11. Phone Number

12. Email Address 13. Fax Number

PART III - TO BE COMPLETED BY THE LOCAL PROPERTY OFFICER (LPO)

14. Local Property Officer Name 15. Phone Number

16. Signature

PART IV - TO BE COMPLETED BY THE INFORMATION SYSTEMS SECURITY BRANCH (ISSB)

18. Security Representative Name 19. Phone Number

20. Signature 21. Date

PART V - TO BE COMPLETED BY THE SYSTEMS CONTROL OFFICER (SCO)

22. Systems Control Officer Name 23. Phone Number

24. Signature 25. Date

PART VI - TO BE COMPLETED BY THE BUILDING SECURITY OFFICER

26. Building Security Officer Name 27. Phone Number

28. Signature 29. Date

PART VII - ADDITIONAL CLEARANCE PROCEDURES

30. Instructions (Enter as appropriate)

Office Authorized Clearance Name and Signature Date Phone Number

PART VIII - TO BE COMPLETED BY THE CBP POINT OF CONTACT

I certify to the best of my knowledge that the named individual returned all issued items and is cleared according to all established procedures. A copy of this form has been forwarded to Internal Affairs.

Date

CBP Form 242 (09/01)

17. Date

31. Signature of Point of Contact

INSTRUCTIONS

This form applies to the separation of a contractor employee; NOT government employees. Use CBP-241, Separation Clearance Certification, for the separation of a government employee.

CONTRACTOR EMPLOYEE

Complete Part I (Items 1 through 7) before forwarding to the Contractor’s Project Manager, no later than 10 days prior to the scheduled separation date, or CBP Point of Contact (CBP/POC), if there is no Contractor Project Manager.

CONTRACTOR’S PROJECT MANAGER

Complete Part I (Items 8 and 9). The Contractor’s Project Manager shall also complete Items 1 through 6 if the contractor employee is unable to do so. Forward the completed form to the CPOC.

CBP POINT OF CONTACT

Customs and Border Protection Office of Internal Affairs Security Programs Division Personnel Security Branch 1300 Pennsylvania Ave., NW Washington, D.C. 20229

CBP Form 242 (09/01)

The CBP/POC may be a Contracting Officer’s Technical Representative (COTR), Contracting Officer, or other designated CBP employee who is monitoring the contract, collectively referred to as the CBP/POC.

1. The CBP/POC shall complete Part I, Items 1 through 6 and 9 if the separating contractor employee or Contractor’s Project Manager did not complete the form.

2. The CBP/POC shall complete Part II.

4. The CBP/POC shall send an electronic mail (email) message to "Voice, Communications", if the contractor employee had a calling card in his/her possession. Provide the contractor employee’s name and card number. After notification, shred the card as instructed.

5. The CBP/POC shall coordinate the return of any Government Furnished Property (GFP), including official credentials;

official passports, desktop or notebook computers, smart cards and associated readers, cameras, cellular phones, pagers, phone calling cards, publications, and any other government owned item(s).

6. The CBP/POC shall ensure all computers (desktops, notebooks, palm PC, etc.) and other equipment having storage capabilities (zip drives, tape drives, floppy diskettes, compact disc, etc.) used to complete the contract shall be purged of any and all information generated or processed in the performance of the contract. Contact the Information Systems Security Branch if assistance is needed.

7. The CBP/POC shall annotate any additional instructions for clearance in Part VII (e.g., mailroom, parking permit, library, and passport). Separate local instructions may be attached.

8. The CBP/POC shall forward the form to each office listed on the form. Facsimile transmissions are authorized. The CBP/POC will complete Part VIII after all clearances have been obtained and forward the form to:

3. The CBP/POC shall ensure that the departing contractor employee’s name is deactivated in the CBP on-line telephone system ("TELE") and remove the contractor employee’s Voice Mail account from the local phone system and local telephone lists, if any.

LOCAL PROPERTY OFFICER (LPO)

The Local Property Officer (LPO) shall take possession of all accountable GFP issued to the departing contractor employee, if the government maintains the official government property records. (Example: Complete CBP 259, Personal Equipment and Clothing Record, for all property issued to a contractor.) The LPO shall notify the CBP/POC if the contractor employee did not return all GFP. (GFP will be returned to the contractor if the contractor maintains government property records.)

The LPO shall complete Part III and return the signed form to the CBP/POC. A facsimile is acceptable.

OFFICE OF INFORMATION TECHNOLOGY, INFRASTRUCTURE SERVICES DIVISION, INFORMATION

SYSTEMS SECURITY BRANCH (ISSB)

FAX: (703) 921-6395

The Information Systems Security Branch (ISSB) shall suspend the contractor employee’s access to all systems authorized access, such as TECS, ACS, and others.

ISSB will complete Part IV and return the signed form to the CBP/POC. A facsimile is acceptable.

LOCAL SYSTEMS CONTROL OFFICER (SCO)

The SCO will review the electronic “Separation Confirmation” message received from ISSB and local records or files to ensure the removal of the contractor employee’s access from all local systems or networks.

The SCO will return the signed form to the CBP/POC. A facsimile is acceptable.

LOCAL BUILDING SECURITY OFFICER (BSO)

ADDITIONAL CLEARANCE PROCEDURES

Annotate any special clearance instructions. The applicable office shall complete the form and return it to the CPOC.

Customs and Border Protection ATTN: SATO Travel 1300 Pennsylvania Ave., NW, Mail Stop C-011 Washington, D.C. 20229 Phone 202-927-0980

CBP Form 242 (09/01)

ISSB will send an email "Separation Confirmation” message to the CBP/POC and all CBP LAN Administrators and Systems Control Officers confirming that the individual’s access to all systems has been suspended.

The BSO will take possession of any building pass, badge, parking permit, keys, passcards, etc. that may have been issued to the departing contractor employee.

The BSO will remove the contractors entry from any locator file and archive any records that must be retained on the contractor employee.

The BSO will return the signed form to the CPOC. A facsimile is acceptable.

Passports issued by the Office of International Affairs must be returned to: