NCIC - CRIMINAL HISTORY CHECK.pdf
PDF 182 KB Posted
- Attached to
- B&F 26Z5AV7 - Emergency Repair of Elevator C&D
- Solicitation number
- 15B51726Q00000014
About this file
This is a Criminal History Check authorization form (BP-A0660) prescribed by the Federal Bureau of Prisons under the U.S. Department of Justice. The form serves as an authorization document allowing FBP representatives to obtain and review an individual's criminal history background as a prerequisite for entry to or service at Bureau facilities, including volunteer and contract positions.
The form requires collection of personal identification information including name, address, contact details, aliases, citizenship status, Social Security number, date of birth, physical descriptors (sex, race, height, weight, eye color, hair color), and place of birth. The applicant must certify the accuracy of provided information through signature and date. According to the Privacy Act Notice, authority for information collection derives from Executive Order 10450 and various USC statutes. The collected information is used to determine fitness for federal employment, clearance to perform contractual services, or security clearance and access eligibility. Information may be furnished to third parties as necessary for official responsibilities. While submission is technically voluntary, failure to provide requested information may result in denial of facility entry, denial of volunteer or contract status, lack of further employment consideration, or termination of existing employment.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
PDF Prescribed by P1280
BP-A0660 CRIMINAL HISTORY CHECK
MAY 18
U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS
AUTHORIZATION FOR RELEASE OF INFORMATION
CRIMINAL HISTORY C HE CK
I hereby authorize a representative of the Federal Bureau of Prisons to obtain information on my criminal history background. I understand that this check must be done before I am allowed to enter/serve at any Bureau facility. I also understand that refusal to provide all necessary information may result in (1) denial of entry into a Bureau facility and (2) denial of volunteer/contract status.
1. Name (Last, First, Middle)
2. Address (Street address City, State, County, Zip Code)
3. Home Telephone Number (Area Code, Number):
4. Aliases/Nickname:
5. Citizenship (List the country you are a citizen of):
6. Social Security Number:
7. Date of Birth (Month, day, year):
8a. Sex: 8b. Race:
8c. Height: 8d. Weight:
8e. Color of Eyes: 9f. Color of Hair:
9. Place of Birth (City, State, County) List city, county, and country if outside the U.S.A.
10. The above- listed information is true and correct.
s Signature
10a. Date
PRIVACY ACT NOTICE
Authority for Collecting Information: E.O. 10450; 5 USC 1303-1305; 42 USC 2165 and 2455; 22 USC 2585 and 2519;
and 5 USC 3301
Purposes and Uses: Information provided on this form will be furnished to individuals in order to obtain information regarding activities in connection with an investigation to determine (1) fitness for Federal employment, (2) clearance to perform contractual service for the Federal Government, (3) security clearance or access. The information obtained may be furnished to third parties as necessary in the fulfil lment of official responsibil ities.
Effects of Non-Disclosures: Furnishing the requested information is voluntary, but failure to provide all or of part the information may result in lack of further consideration for employment, clearance or access, or in the termination of your employment.
File details come from the government source that posted it. Updated .