Self Certification Form.pdf
PDF 102 KB Posted
- Solicitation number
- 36C24523Q0801
About this file
This document contains a self-certification form and details of a related federal contract opportunity. The self-certification form requires contractors to disclose any breaks in previous federal employment lasting over 60 days to be considered for the contract opportunity.
The related federal contract opportunity is solicitation number 36C24523Q0801 for fire extinguisher maintenance services at the Washington DC VA Medical Center. The solicitation is issued by the Department of Veterans Affairs Veterans Health Administration VISN 5. No further specifics are provided on pricing, response deadline, or other requirements for the fire extinguisher maintenance services.
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Other files
| File | Type | Posted |
|---|---|---|
| S06_36C24523Q0801 0001.docx | DOCX document | |
| S02_MAP DCVAMC EXTINGUISHER LAYOUT.pdf | ||
| P09_FINAL SOW FIRE EXTINGUISHER.docx | DOCX document | |
| S02_36C24523Q0801 Line Items.xlsx | XLSX spreadsheet | |
| S02_Wage Determination Washington DC.pdf | ||
| OF 306 Fillable (2019 ver).pdf | ||
| VSC Security Request Packet_Complete Packet_APRIL 2012.pdf | ||
| 36C24523Q0801_1.docx | DOCX document |
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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 .