NVARNG Personal Security Questionnaire.pdf
PDF 141 KB Posted
- Attached to
- National Guard - Landscaping Services
- Solicitation number
- 43ADG-S4013
- Issued by
- Nevada
About this file
This is a Personal Security Questionnaire document prepared by the Nevada Army National Guard (NVARNG) in connection with a landscaping services procurement for the Nevada Office of the Military under the Nevada Department of Adjutant General and National Guard. The questionnaire is designed to collect security-related information from prospective vendors and their personnel who may require access to military facilities or sensitive areas during the performance of landscaping services. The document establishes baseline security requirements and vetting procedures that must be completed prior to contract award or commencement of work on state military installations.
The questionnaire requests detailed personal and professional background information from vendors and key personnel, including but not limited to identification verification, employment history, references, and any relevant security clearances or certifications. Completion and submission of this security questionnaire appears to be a mandatory prerequisite for bid consideration, as it enables the Nevada National Guard to conduct appropriate security screening and determine vendor and personnel eligibility to access military properties and installations where landscaping work will be performed.
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Other files
| File | Type | Posted |
|---|---|---|
| 43ADG-S4013 - Request for Qualifications~1.pdf | ||
| 43ADG-S4013-Insurance Requirements.pdf | ||
| Terms-and-conditions-for-services~6.pdf | ||
| 43ADG-S4013 RFQ_Vendor_Qualifications_Response_Form~1.xlsx | XLSX spreadsheet | |
| 43ADG-S4013 RFQ Service Locations~1.xlsx | XLSX spreadsheet | |
| Certification-regarding-lobbying~7.pdf | ||
| 43ADG-S4013_Cost_Schedule.xlsx | XLSX spreadsheet | |
| 43ADG-S4013 - NOM Standard Form Contract.docx | DOCX document | |
| NVARNG Environmental Policy Statement.pdf | ||
| 43ADG-S4013 -Vendor-Information-Response.pdf | ||
| 43ADG-S4013 Scope of Work.pdf | ||
| Quote Instructions.pdf |
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Text version
THIS IS A SAMPLE FOR YOUR REVIEW ONLY
NVARNG PERSONAL SECURITY QUESTIONNAIRE
1. Name: ________________, ________________, _________________ Last First Middle (full name)
2. Date of Birth: __________________________ (Month Day, Year)
3. Social Security Number: _________ - ______ - _________
4. Sex: MALE____FEMALE___
5. Driver’s License Number______________________________________
6. Driver’s License State of Issue_________________________________
7. Home Address_____________________________________________
8. City______________________________________________________
9. State_____________________________________________________
10. Place of Birth:__________________________ (City, State, Zip, Country)
11. Employer/Command:________________________________________
12. Phone Numbers: Employer (____) ____-____ Home (____) ____-____
YES NO NA
Are you a U.S. Citizen?
Are you a legal resident alien?
Have you ever been barred from any federal government facility or base?
Have you ever been convicted of a felony?
Do you have any outstanding warrants or are you a fugitive from justice?
Are you currently pending trial?
Are you on an approved Dept. of Prisons program? (probation, parole, work release etc.)
Have you ever been convicted on a weapons charge or Theft
13. Individual Requesting Access. I certify that the above information is correct and I agree to allow NVARNG Provost Marshal and/or local commands to perform a local/national security check on me as required.
Signature: ________________________Date:_________________
14. Employer Supervisor/Manager. I certify that the above information has been verified with the individual’s documents; to include a United States issued birth certificate and a United States issued picture identification (e.g., driver’s license, U.S. military ID, Resident Alien Registration Card, Foreign Passport, Foreign Military ID etc.)
Signature: __________________________Date:_________________
15. FMO/NVNG Representative – Print Name_______________________
Signature: __________________________Date:_________________
Project:________________________Location:_________________________
Contract start date:_______________Contract end date:__________________
File details come from the government source that posted it. Updated .