OAG Background Form - Employee Information.pdf
PDF 230 KB Posted
- Attached to
- 14, OAG Janitorial Svs - Wilkes Barre
- Solicitation number
- 6100043603
- Issued by
- Luzerne County, Woodcock Borough, Pennsylvania
About this file
This document appears to be an Authority for Release of Information and Records form related to a state or local government contract opportunity. It requests employee information such as name, address, contact details, employment history, and references. The form notes that this information is required for each employee who will be performing services on the contract. No other details about the specific contract opportunity are provided in this document.
The document does not contain information about the products or services requested, project overviews, response dates, award dates, pricing terms, set asides, funding requirements, or other salient contract details. It is solely focused on collecting personal and employment information for the contracted employees.
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Text version
AUTHORITY FOR RELEASE OF INFORMATION AND RECORDS
EMPLOYEE INFORMATION
NAME:
ADDRESS:
TELEPHONE NO.: MOBILE NO.:
SOCIAL SECURITY NO.: DRIVER’S LICENSE NO.:
DATE OF BIRTH:
REFERENCE NO. 1 (NAME, ADDRESS AND TELEPHONE NO.)
REFERENCE NO. 2 (NAME, ADDRESS AND TELEPHONE NO.)
REFERENCE NO. 3 (NAME, ADDRESS AND TELEPHONE NO.)
LIST NAMES, ADDRESSES AND TELEPHONE NUMBERS OF ALL PAST EMPLOYERS. USE
ADDITIONAL PAPER IF NECESSARY.
NAME AND ADDRESS OF EMPLOYER’S ORGANIZATION
DATES EMPLOYED (GIVE MONTH AND YEAR)
EXACT TITLE OF YOUR POSITION
NAME OF IMMEDIATE SUPERVISOR
(AREA CODE) PHONE No.
AUTHORITY FOR RELEASE OF INFORMATION AND RECORDS
NOTE
PLEASE FORWARD THE FOLLOWING INFORMATION FOR EACH EMPLOYEE WHO WILL BE PERFORMING SERVICES
ON THIS CONTRACT:
1. AUTHORITY FOR RELEASE OF INFORMATION AND RECORDS FORM
2. INFORMATION BACKGROUND INVESTIGATION SHEET
3. COPY OF BIRTH CERTIFICATE
4. COPY OF DRIVER’S LICENSE AT 150% EXPOSURE
5. COPY OF SOCIAL SECURITY CARD AT 150% EXPOSURE
6. COPY OF VISA FOR NON-U.S. CITIZENS
File details come from the government source that posted it. Updated .