NCIC CONSENT FORM.pdf
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- Solicitation number
- W912PM24B0001
About this file
The document is a National Crime Information Center (NCIC) Consent Form, which is used to authorize and voluntarily consent to a criminal background check conducted by the 596th Transportation Brigade Provost Marshal's Office for the purpose of obtaining access to the Military Ocean Terminal, Sunny Point (MOTSU). The form requires the applicant to provide personal information such as full name, date of birth, race, gender, place of birth, social security number, driver's license information, address, and contact information. The applicant must also indicate if they are currently on probation/parole or have pending charges, and confirm if they are a U.S. citizen. The form states that individuals with serious criminal convictions or a pattern of criminal activity prejudicial to good order and discipline will be denied access to MOTSU.
The related federal contract opportunity is for the MOTSU Berm Repair Construction FY24 project in Brunswick County, North Carolina. The U.S. Army Corps of Engineers, Wilmington District intends to award a single Firm Fixed Price contract for site preparation work, including heavy tree clearing, sediment and erosion control, potential wetland mitigation, and earthwork to bring deficient earthen berms into compliance with explosive safety requirements. The North American Industry Classification System (NAICS) code is 237990 - Other Heavy and Civil Engineering Construction, and the magnitude of construction is between $10,000,000 and $25,000,000. This is a 100% Competitive Small Business set-aside solicitation, with a registration requirement in the System for Award Management (SAM).
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NCIC CONSENT FORM
National Crime Information Center (NCIC) Inquiry Authorization and Waiver
1. In accordance with 596th Transportation Brigade Regulation 190-13, all persons requesting admittance to
Military Ocean Terminal, Sunny Point will be subjected to an NCIC inquiry. This inquiry is a criminal background check utilizing the Federal Bureau of Investigation (FBI) criminal database.
2. Individuals who are determined to have been convicted of serious crimes (felonies, as determined by state statutes); or pattern of criminal activity, which is determined to be prejudicial to good order and discipline on a military installation (as determined by the Provost Marshal, Senior Law Enforcement Official, or designated representative) will be denied access.
3. An NCIC inquiry will produce a complete criminal history background on the individual, which will be maintained on file at the Visitor Center, under the control of the installation Provost Marshal for one year. After one year, the documents will be destroyed. NCIC results will only be viewed by authorized MOTSU security personnel.
The NCIC results of persons denied access to MOTSU will not be maintained. Disclosure of information obtained through an NCIC inquiry is governed by the North Carolina State Bureau of Investigation and the FBI.
This form is to be completed by the applicant. All areas below are MANDATORY. Incomplete information will be returned to the applicant without action.
I (print FULL NAME: FIRST, MIDDLE, LAST)________________________________________________________, have read the information presented above and understand the contents. I specifically authorize and voluntarily consent to a National Crime Information Center background check conducted by the 596th Transportation Brigade Provost Marshal’s Office for the purpose of obtaining access to the Military Ocean Terminal, Sunny Point.
Signature of Requestor Today’s Date
Date of Birth Race Gender Place of Birth (City and State)
Social Security Number Driver’s License #/State Street Address
Are you currently on probation or parole? YES___ NO___ ______________________________ City, State Do you currently have pending charges? YES___ NO___ Are you a US Citizen? YES___ NO___ Zip Code
Company Name Telephone Number (Home or Cell)
Military Ocean Terminal, Sunny Point, Point of Contact and Telephone Number
(CONTRACTORS ONLY)
**NOTE**If your Driver’s License has the “NOT FOR FEDERAL IDENTIFICATION”, you must have another form of Government Photo ID to enter Sunny Point Military Ocean Terminal. This is IAW Dept. of Homeland Security REAL ID Act.
| read the information presented above and understand the contents I specifically authorize and voluntarily consent: |
| Todays Date: |
| Date of Birth: |
| Race: |
| Gender: |
| Place of Birth City and State: |
| Social Security Number: |
| Drivers License State: |
| Street Address: |
| City State: |
| Zip Code: |
| Company Name: |
| Telephone Number Home or Cell: |
| Military Ocean Terminal Sunny Point Point of Contact and Telephone Number: |
| Check Box3: Off |
| Check Box4: Off |
| Check Box5: Off |
| Check Box6: Off |
| Check Box7: Off |
| Check Box9: Off |
File details come from the government source that posted it. Updated .