LEDS - WORD DOCUMENT.docx
DOCX document 53 KB Posted
- Attached to
- OSP - PUMPS
- Solicitation number
- S-29100-00003739
- Issued by
- Marion County, Oregon
About this file
This document is a request for background verification data and LEDS (Law Enforcement Data System) check from the Oregon Department of Corrections. The purpose is to obtain personal information, including name, date of birth, social security number, height, weight, eye color, hair color, driver's license number, and address, to conduct a LEDS check on the individual. The information provided will be used solely for the indicated purpose and handled with confidentiality. The individual must sign the form to grant permission for the LEDS check.
The related state and local contract opportunity is for the procurement of a pump per the plans, drawings, and specifications. The contract is being issued by the Oregon Department of Corrections and the jurisdictions involved are Marion County and the City of Salem. The contract details, such as bid documents, item quantities, response dates, and award information, are not provided in this document.
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Other files
| File | Type | Posted |
|---|---|---|
| OSP PUMP - BID DOCUMENTS.pdf | ||
| C2022277_RFP_DEITrainingDevelopmentandDelivery_finalforPDF.docx | DOCX document |
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Text version
Last Middle First )Purpose: Name:
SECTION 6
OREGON DEPARTMENT OF CORRECTIONS
Request for Background Verification Data/LEDS Date:
OSP PUMPS
Month Day Year )Other Names: Date of Birth:
(Optional o r last
4-digits only) )Social Security #:
COMPANY NAME:______________________
Height:
Weight:
Eye Color:
Hair Color:
State:
)Driver’s License#:
Address:
Phone #:
OJIN Needed:
Yes No
Section Requesting LEDS Check: Institution/Facility:
State(s) Wanted for LEDS Check:
The information provided will be used only for the purpose indicated above and will be handled with confidentiality.
By signing, you grant DOC permission to run a LEDS check and certify that the information provided above is correct and true to the best of your knowledge.
Signature:
Information/Permission received by phone.
Function Unit Manager/Designee must review and approve in all cases where criminal history is discovered.
No Criminal Record
Criminal Record
Approved
Denied
Reviewed by FUM:
LEDS Check Completed By:
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File details come from the government source that posted it. Updated .