Personal Security Questionnaire.docx
DOCX document 22 KB Posted
- Attached to
- Fencing & Gates Repairs & Installation
- Solicitation number
- 43ADG-S1577
- Issued by
- Washoe County, Nevada
About this file
The document provided is a Personal Security Questionnaire for the Nevada Army National Guard (NVARNG). The questionnaire collects personal information such as name, date of birth, Social Security number, driver's license details, and employment information. It requires the individual to certify the accuracy of the information provided and allows NVARNG Provost Marshal and/or local commands to perform a local/national security check.
The related state and local contract opportunity is for fencing and gates repairs and installation services for the NVARNG throughout the state of Nevada, including the jurisdictions of Carson City. The contract will be for multiple years and is dependent on the availability of funding provided by the National Guard Bureau.
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Other files
| File | Type | Posted |
|---|---|---|
| NV Army National Guard Environmental Policy.pdf | ||
| ATTACHMENT B Vendor Certification.pdf | ||
| LetterOfIntent~1.pdf | ||
| ATTACHMENT D - Insurance Schedule~1.docx | DOCX document | |
| ATTACHMENT A Confidentiality and Certification of Indemnification.pdf | ||
| NV Army National Guard Section 010000 - Safety and Security.pdf | ||
| ATTACHMENT H Certification Regarding Lobbying.pdf | ||
| Quote Instructions.pdf | ||
| RFP Final~2.docx | DOCX document | |
| ATTACHMENT I Federal Laws and Authorities.pdf | ||
| Standard Contract Form~1.docx | DOCX document | |
| UFC 4-022-03 Security Fences and Gates.pdf | ||
| ATTACHMENT G COST SCHEDULE.docx | DOCX document | |
| Service Agreement.docx | DOCX document | |
| Proposed Staff Resume - 04-05-17~2.doc | DOC document | |
| Reference Questionnaire - 01-24-20~2.doc | DOC document |
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Text version
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:__________________
ANNEX D
Appendix 3
TAB 3
File details come from the government source that posted it. Updated .