SOW Attachment 3- PIV Badge Template .pdf
PDF 293 KB Posted
- Attached to
- Y1DA--402-24-007 B200E Lobby Flooring
- Solicitation number
- 36C24125R0098
About this file
This document is a PIV (Personal Identity Verification) Badge Request Form for the VA Maine Healthcare System Police Department. The form requires detailed personal information for badge issuance, including name, address, social security number, gender, service line, contact information, date of birth, place of birth, and occupation title. The form provides options to request PIV, NON-PIV, or FLASH badge types, with a specific section for engineers to complete contract end date and service line official information. The second page of the document is reserved for TOGUS Police Department use, with sections to check VISTA, VAPS, and local records, and to track the badge request status and HR advancement.
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| 36C24125R0098 0002.docx | DOCX document | |
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| SOW - B200E Lobby Flooring.docx | DOCX document | |
| 402-24-007 BLD 200E Lobby Flooring ICRA.pdf | ||
| 402-24-007 B200E Lobby Flooring PCRA.pdf | ||
| 36C24125R0098_1.docx | DOCX document | |
| Highlighted Floor Plan.pdf |
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Text version
Project Name: Type of Badge Requested: PIV NON-PIV FLASH
Circle one
Departmentof Veterans Affairs
VA Maine Healthcare System
Police Department
1 VA Center 07B
Augusta, ME 04330
207 623-5796
Last Name First Name Middle
Physical Street Address City State and Zip Code
Social Security Number
Gender (M) (F)
Service Line or Company Name Company or Cell Phone Number
Date of Birth
Place of Birth Occupation Title
Personal email for activation of badge process
For Engineers to fill out:
Contract end date:
Service Line Official Date
All highlighted info must be submitted, or a badge cannot be issued
FOR TOG US POLICE USE ONLY
VISTA RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
VAPS RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
LOCAL RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
STATUS F YES NO ADVANCED TO HR
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File details come from the government source that posted it. Updated .