Job_Walk_Security_Clearance_Application_Request.pdf
PDF 168 KB Posted
- Attached to
- Maintenance and Repair of Detention Locks
- Solicitation number
- IFB 060-2806701-AM
- Issued by
- Orange County, San Francisco City, California
About this file
This is a Security Clearance Application Request form issued by the Orange County Sheriff-Coroner Department in California for individuals seeking access to the Orange County Jail or Court system. The form requires applicants to provide comprehensive personal information including full name, residence address, Social Security number, driver's license number, date of birth, physical characteristics, employment details, and emergency contact information. Applicants must certify that all information provided is true and correct and authorize the Orange County Sheriff's Department to conduct a criminal background investigation as a condition of entry into county detention or court facilities. The form was revised on November 8, 2016, and completed applications must be submitted to amitchell@ocsheriff.gov, after which applicants will receive instructions for electronic submission of additional security clearance documentation.
This security clearance application is associated with the Orange County Sheriff-Coroner Department's competitive bid solicitation for Maintenance and Repair of Detention Locks. Any contractor or vendor selected for work on this contract, or individuals working on the contractor's behalf who require access to detention facilities or court systems, would be required to complete this security clearance application and background check process. The County emphasizes that omissions, falsifications, or misstatements on the application will result in denial and that all submitted information will be verified through the background investigation process.
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Text version
Revised 11-8-16
ORANGE COUNTY
SHERIFF-CORONER DEPARTMENT
SECURITY CLEARANCE APPLICATION
Please read and answer all questions. Information you provide will be verified and a criminal background check will be conducted. Any omissions, falsifications or misstatements on this application will result in your application being denied.
Return completed application request to amitchell@ocsheriff.gov. Once received, information on how to electronically submit security clearance information will be provided.
PRINT ALL INFORMATION - Contractor Volunteer Notary Paralegal Other
Full Name
Residence Address City Zip
Res. Phone Soc. Sec. # Drivers. Lic. # State
Cell Phone E-Mail Address
Age DOB HT. WT Eyes Hair
Employer Phone
Immediate Supervisor’s Name Phone
Employer’s Address City Zip
Emergency Contact Information
Name: Telephone: Day Evening
Address City Zip
Relationship
I hereby certify that the above information is true and correct. I acknowledge that this Security Clearance form is the property of the Orange County Sheriff’s Department.
As a condition of my request to enter the Orange County Jail or Court system I hereby authorize the Orange County Sheriff’s Department to conduct a criminal background investigation.
Signature of Applicant: Date:
File details come from the government source that posted it. Updated .