OCFS-4716 Contractor Employee Background Certification.doc
DOC document 49 KB Posted
- Attached to
- IFB # 1038 Statewide Chef Services Consultant
- Solicitation number
- 2064716
- Issued by
- Sullivan County, New York
About this file
This document is a Contractor Employee AND Volunteer Background Certification form from the New York State Office of Children and Family Services (OCFS). It requires contractors and volunteers to certify that they have not been convicted of a crime or have any pending criminal charges, except as disclosed. Failure to certify truthfully may result in denial of contact with youth in OCFS custody and denial of access to information related to youth in OCFS custody, as well as other actions deemed necessary by OCFS.
The document does not contain information about a state or local contract opportunity. It is solely focused on the background certification requirements for contractors and volunteers working with OCFS.
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| Attachment 1 - Bidder's Certified Statements LOCKED.docx | DOCX document | |
| Attachment 3 - DJJOY Facility Map.pdf | ||
| Award Notification IFB 1038.pdf | ||
| IFB 1038 Q&As FINAL 5-4.pdf | ||
| OCFS-0910 Request for Bid Form IFB#1038 FINAL.docx | DOCX document | |
| ac3290s2.pdf | ||
| Attachment 2 - References FINAL1.docx | DOCX document |
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Text version
OCFS-4716 (Rev. 11/2012)
NEW YORK STATE
OFFICE OF CHILDREN AND FAMILY SERVICES
Contractor Employee AND vOLUNTEER Background Certification (Initials are required in space provided for paragraphs 1 and 2 below) I Certify to the best of my knowledge and belief that:
| 1. |
I have not been convicted of a crime in New York State or any other jurisdiction except as follows:
| Crime |
| Conviction Date |
| Court |
| 2. |
I have no criminal charges pending against me in New York State or any other jurisdiction except as follows:
| Crime |
| Conviction Date |
| Court |
I understand that my failure to certify truthfully and accurately to the above statements may constitute grounds for denial of any contact with youth in the custody of the Office of Children and Family Services (OCFS) and denial of access to any information related to youth in the custody of OCFS. In addition, OCFS may take such other actions as it deems necessary and appropriate.
(Signature)
(Printed Name)
(Address)
Sworn to before me this day of , 20 , Notary Public – State of New York
My Commission Expires
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