VA Form 0710.pdf
PDF 717 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 VA form authorization for release of credit information and a related federal contract opportunity notice. The VA form is a standard template authorizing the department to obtain an individual's credit reports from consumer reporting agencies for employment purposes. It specifies the authorization is valid for five years or upon termination of affiliation with VA.
The related federal contract opportunity is a solicitation to renovate the basement of Building 126 at the Tibor Rubin VA Medical Center in Long Beach, California for administrative offices and to address facility condition assessment deficiencies. The solicitation number is 36C25820B0019 and is being issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 22. The work includes renovating the basement space for administrative use and resolving identified facility deficiencies.
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 | ||
| BIDSET_VOL-1.pdf | ||
| 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 | ||
| 36C25820B0019.pdf | ||
| OPM Form 306.pdf | ||
| RFI Form.doc | DOC document | |
| 600-14-114 SPECS and DWGs 2.zip | ZIP file | |
| Contractor Background Investigation Request Form.pdf | ||
| 600-15-136 SPECS Folder.zip | ZIP file | |
| Self Certification.pdf |
Show all 19
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Text version
AUTHORIZATION FOR RELEASE OF INFORMATION
PROTECTED UNDER THE FAIR CREDIT REPORTING ACT (TITLE 15, SECTION 1681)
STATEMENT OF AUTHORIZATION AND CLARIFICATION OF PURPOSE
I Authorize the Department of Veterans Affairs (VA), and authorized agents, to obtain my credit reports from any consumer or credit reporting agency for employment purposes.
The Fair Credit Reporting Act, as amended (15 U.S.C. § 1681, et seq.) allows VA to get one or more credit reports on you for employment. Should a decision to take any adverse action against you be made, based either in whole or in part on the credit report, you should know that the consumer or credit reporting agency that provided the report has played no role in the decision to take action.
VA is requesting an investigation to determine your fitness to work for, or on behalf of, the Federal Government. The information in this authorization will be given to the consumer or credit reporting agency so that the agency will release information about you and your credit history. This information may be disclosed to other Federal Agencies to fulfill official responsibilities, to the extent that the disclosure is permitted by law.
I Understand that the information released by records custodians and sources of information is for official use by the Department of Veterans Affairs, all affiliated agencies and departments, to determine suitability and/or fitness for employment on the behalf of the Federal Government.
Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for (5) years from the date signed or upon the termination of my affiliation with the Department of Veterans Affairs, whichever is sooner.
SIGNATURE OF EMPLOYEE (Sign in ink) TYPE OR PRINT LEGIBLY FULL NAME DATE SIGNED
OTHER NAMES USED HOME TELEPHONE NUMBER (Include Area Code)
CURRENT ADDRESS (Include Street, City, State, and ZIP Code)
VA FORM
JUL 2017 0710
\\iaimain\apps1\Pam_Ward\Logos\Formlogo.jpg Department of Veterans Affairs
AUTHORIZATION FOR RELEASE OF INFORMATION
PROTECTED UNDER THE FAIR CREDIT REPORTING ACT (TITLE 15, SECTION 1681)
AUTHORIZATION FOR RELEASE OF INFORMATION PROTECTED UNDER THE FAIR CREDIT REPORTING ACT (TITLE 15, SECTION 16 81)
STATEMENT OF AUTHORIZATION AND CLARIFICATION OF PURPOSE
Statement of Authorization and Clarification of Purpose I Authorize the Department of Veterans Affairs (VA), and authorized agents, to obtain my credit reports from any consumer or credit reporting agency for employment purposes.
The Fair Credit Reporting Act, as amended (15 U.S.C. § 1681, et seq.) allows VA to get one or more credit reports on you for employment. Should a decision to take any adverse action against you be made, based either in whole or in part on the credit report, you should know that the consumer or credit reporting agency that provided the report has played no role in the decision to take action.
VA is requesting an investigation to determine your fitness to work for, or on behalf of, the Federal Government. The information in this authorization will be given to the consumer or credit reporting agency so that the agency will release information about you and your credit history. This information may be disclosed to other Federal Agencies to fulfill official responsibilities, to the extent that the disclosure is permitted by law.
I Understand that the information released by records custodians and sources of information is for official use by the Department of Veterans Affairs, all affiliated agencies and departments, to determine suitability and/or fitness for employment on the behalf of the Federal Government.
Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for (5) years from the date signed or upon the termination of my affiliation with the Department of Veterans Affairs, whichever is sooner.
I Authorize the Department of Veterans Affairs (VA), and authorized agents, to obtain my credit reports from any consumer or credit reporting agency for employment purposes.
The Fair Credit Reporting Act, as amended (15 U.S.C. § 1681, et seq.) allows VA to get one or more credit reports on you for employment. Should a decision to take any adverse action against you be made, based either in whole or in part on the credit report, you should know that the consumer or credit reporting agency that provided the report has played no role in the decision to take action.
VA is requesting an investigation to determine your fitness to work for, or on behalf of, the Federal Government. The information in this authorization will be given to the consumer or credit reporting agency so that the agency will release information about you and your credit history. This information may be disclosed to other Federal Agencies to fulfill official responsibilities, to the extent that the disclosure is permitted by law.
I Understand that the information released by records custodians and sources of information is for official use by the Department of Veterans Affairs, all affiliated agencies and departments, to determine suitability and/or fitness for employment on the behalf of the Federal Government.
Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for (5) years from the date signed or upon the termination of my affiliation with the Department of Veterans Affairs, whichever is sooner.
SIGNATURE OF EMPLOYEE (Sign in ink)
TYPE OR PRINT LEGIBLY FULL NAME
DATE SIGNED
OTHER NAMES USED
HOME TELEPHONE NUMBER (Include Area Code) CURRENT ADDRESS (Include Street, City, State, and ZIP Code)
VA FORM
JUL 2017
V A Form 0 7 1 0, JULY 2017 VA Form 0710, AUTHORIZATION FOR RELEASE OF INFORMATION
PROTECTED UNDER THE FAIR CREDIT REPORTING ACT (TITLE 15, SECTION 1681)
0710, Authorization, Release, Information, Protected, Fair, Credit, Reporting, Act Missie Vaccaro-Palomaki
MAY 1998
July 2017 Trish Moore (07)
| Signature of Employee Sign in ink: |
| TYPE OR PRINT LEGIBLY FULL NAME: |
| DATE SIGNED: |
| OTHER NAMES USED: |
| HOME TELEPHONE NUMBER (Include Area Code): |
| CURRENT ADDRESS (Include Street, City, State, and ZIP Code): |
File details come from the government source that posted it. Updated .