Fillable CONTRACTOR/EMPLOYEE FINGERPRINTING REQUEST FORM #2 (University of California, Berkeley)

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CONTRACTOR/EMPLOYEE FINGERPRINTING REQUEST FORM #2 (University of California, Berkeley)

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The CONTRACTOR/EMPLOYEE FINGERPRINTING REQUEST FORM #2 (University of California, Berkeley) form is 1 page long and contains:

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Revised Form November 2018
Department of Veterans Affairs
VHA Service Center Personnel Security
6100 Oak Tree Blvd #500
Independence, OH 44131
VSC.Security@va.gov
CONTRACTOR/EMPLOYEE FINGERPRINTING REQUEST FORM #2
SON: 955C / SOI: VA08 IPAC/OPAC: 3600.1200
(Please see Instructional Form #2a for assistance in completing this form)
** This form must be taken to the fingerprinting appointment **
EMPLOYEE INFORMATION (PLEASE PRINT)
A Full Legal Name (First Middle Last):
B SSN Last Four:
C Contractor/Federal/Other:
WE DO NOT REQUIRE THIS FORM BACK UNLESS THE PRINTS ARE MANUAL.
FACILITY INFORMATION
Electronically / Manually **Manual Prints will delay your prescreening**
D VAMC Name & Location:
E PIV Office Official :
F Date Fingerprinted:
G Method of Fingerprinting:
H Date Card Mailed to VSC:
(Name of trainee to be fingerprinted)
Health Professions Trainee
691/GLA Healthcare System, Los Angeles, CA
(Manager/Sponsor Name):
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CONTRACTOREMPLOYEE FINGERPRINTING REQUEST FORM 2 (University of California, Berkeley)

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Completed 7 November 2021

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