J-5_Sample_NPS_Park_Identification_Card-PIV_Requiremnet__1.pdf

This is an ID Application and Background Check Request form used by the United States Park Police (USPP) for the Statue of Liberty National Monument and Ellis Island. The form is designed to collect personal information and conduct background investigations prior to employment or entry on duty, determining applicant suitability and fitness for USPP positions.

The form requires applicants to provide comprehensive biographical data including name, date of birth, physical characteristics, citizenship status, and current address. Applicants must disclose employment history, including any current or prospective employer information with supervisor contact details. The form includes mandatory questions regarding criminal history (arrests, charges, or convictions), employment termination or dismissal, prior employment at Liberty Island, Ellis Island, Battery Park, or Liberty State Park, military service, and membership in organizations that advocate commission or use of force or violence to overthrow the U.S. government. Applicants must certify that all information provided is true and accurate, understanding that false or fraudulent information may result in federal facility barring and fines or imprisonment under Title 18, USC 1001. The form requires submission of two forms of identification with at least one being primary (such as U.S. Passport, Permanent Resident Card, Driver's License, or Military ID), and secondary options include Social Security Card, birth certificate, government-issued photo ID, TSA credentials, voter registration, or citizenship documentation. The Privacy Act Statement explains that the USPP collects this information pursuant to Executive Order 10450 and related authorities for background investigation purposes, with voluntary submission required to avoid delays in background clearance determinations.