SF-Mint-Form-117_(Revised)-Philadelphia.xls
XLS spreadsheet 37 KB Posted
- Solicitation number
- USM-HQ-17-0007
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Background Document
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Other files
| File | Type | Posted |
|---|---|---|
| Lerch_Bates_-Elevator_Report.pdf | ||
| Background_Clearance_Form.doc | DOC document | |
| Lifejacket_Sales_Sheet.pdf | ||
| Solicitataion-USM-HQ-17-0007-Elevator_Modernization-Philly.pdf |
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Text version
A
| SFM-117 | |||||||||||
| U. S. Mint | (02/92) | ||||||||||
| Philadelphia, PA | Pre - Hire | ||||||||||
| Security Clearance Request | |||||||||||
| DATE: | |||||||||||
| ORIGINATOR: Ray Dibble/T.Gannon | Contractor, | ||||||||||
| Visitor, Etc.: | |||||||||||
| Typewritten, Capital Letters and | Social Security | Date of | State and | Place of Birth | Alien Reg # or | Sex | NCI | C Results | |||
| in Alphabetical Order: | Number | Birth | DRIVER'S LIC. | (City/State) | Cert. Of Nat. or | Y | N | W | Date | Initial | |
| Full Name ( LAST, FIRST, & MIDDLE) | Number | Passport # | CLEARED | ||||||||
| Requestor: | Notified: | ||||||||||
| Date: | Date: | ||||||||||
| Date Copy Sent: | |||||||||||
| Note to Originator: Please provide all information listed; otherwise, it will prevent us from obtaining accurate and timely result. | |||||||||||
| All contractor employees must be U.S. citizens or have lawful permanent resident alien status. | |||||||||||
| Proof of citizenship is required for those citizens born outside of the U.S. | |||||||||||
| Acceptable proof is either a Permanent Resident Status card, Certificate of Naturalization, U.S. Passport or Certificate of birth abroad. |
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