Self Certification.pdf
PDF 102 KB Posted
- Attached to
- RENOVATE BLDG. 126 OP BASEMENT FOR ADMIN OFFICES Federal contract opportunity
- Solicitation number
- 36C25820B0019
About this file
This document contains a self-certification form and details of a federal contract opportunity. The self-certification form is for employees of the Department of Veterans Affairs to indicate if they have had a break in federal service and includes fields for name, social security number, signature, and dates.
The related federal contract opportunity is a solicitation from the Department of Veterans Affairs Veterans Health Administration for renovations to Building 126 at the Tibor Rubin VA Medical Center in Long Beach, California. Specifically, the solicitation is to renovate the basement of the building for administrative offices and correct facility condition assessment deficiencies. No further details are provided on response dates, award dates, pricing terms, or set-asides.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Revised RFIs Log as of 8-14-2020 .pdf | ||
| 600-16-114 _ attendance bidders sheet 7 30 2020.pdf | ||
| RFIs Questions and Answers Log 8-12-2020 .pdf | ||
| 36C25820B0019 0004.pdf | ||
| 600-16-114 FINALSPEC-VOL2.pdf | ||
| 36C25820B0019 0003.pdf | ||
| 36C25820B0019 0001.pdf | ||
| 36C25820B0019.pdf | ||
| OPM Form 306.pdf | ||
| RFI Form.doc | DOC document | |
| 600-14-114 SPECS and DWGs 2.zip | ZIP file | |
| PIV Office Fingerprint Request Form.pdf | ||
| 7.31.2019 Matrix for CFMs Contractors PIV Process.sc.pdf | ||
| 600-14-114 SPECS Folder.zip | ZIP file | |
| 600-16-114 APPENDIX-CD.pdf | ||
| BIDSET_VOL-1.pdf | ||
| VA Form 0710.pdf | ||
| Contractor Background Investigation Request Form.pdf | ||
| 600-15-136 SPECS Folder.zip | ZIP file |
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Text version
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 .