RFP Attachment (9)_Cont Federal Employment.pdf

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Attached to
Ground Ambulance and Related Services - VA EKHCS -Amendment 0001
Solicitation number
36C25520R0084
Issued by

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Other files

File Type Posted
Attachment B -36C25520R0084 - Amendment Questions and Answers-.pdf PDF
Attachment A -RFP Amendment Pages - Added language in Red- 36C25520R0084- Ambulance Services EKHCS.pdf PDF
RFP Amendment 36C25520R0084 0001.pdf PDF
RFP Attachment (3) - Declaration for Federal Employment - Optional Form 306.pdf PDF
RFP Attachment (1) - Past Performance Questionaire.pdf PDF
RFP Attachment (2) - Authorization for Release of Information.pdf PDF
36C25520R0084- Ambulance Services EKHCS.pdf PDF
RFP Attachment (6) _ Frequency Chart.pdf PDF
RFP Attachment (8)_Fingerprinting Form 2.pdf PDF
RFP Attachment (7)_Form 1B -Security_ServicesRequestForm_Supplemental.pdf PDF
RFP Attachment (5) DOL WD 2015-5339 Rev 11 Dated 6-30-2020.pdf PDF
RFP Attachment (4) DOL WD 2015-5105 Rev 11 Dated 6-26-2020.pdf PDF
RFP Attachment (10)_PIV Sponsorship.pdf PDF
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DEPARTMENT OF VETERANS AFFAIRS

SECURITY AND INVESTIGATIONS CENTER

Self Certification of Continuous Service

I hereby certify my break in service from my last federal employment is indicated by the block checked below.

I have NOT had a break in service.

My break in service was less than 60 days.

My break in service was greater than 60 days, but less than 2 years. (You are required to submit the OF 306, Declaration for

Federal Employment, with this form.)

My break in service is greater than 2 years or; I have never had employment through the federal government.

Print Name: Social Security Number:

Signature: Date:

VA Personnel Security/HR Use Only:

Current Investigation in PIPS: Date:

Risk level of current position: Verified by:

(Check One)

Federal employment is defined as any branch of the United States military (Active, Guard or Reserve), federal government civilian employee (any federal government agency), or a contractor working for the federal government.

Self Certification of Continuous Service Form Revised February 14, 2017

Previous Versions are Obsolete

I have NOT had a break in service: Off
My break in service was less than 60 days: Off
My break in service was greater than 60 days but less than 2: Off
My break in service is greater than 2 years or I have never worked: Off
Print Name:
Social Security Number:
Date:
Current Investigation in PIPS:
Date_2:
Risk level of current position:
Verified by:

File details come from the government source that posted it. Updated .