BOP Program Statement 3000.03 § 30

X X X - -

(This form may be locally copied or BP-S-155(30)

locally reproduced via wordprocessing) SEP 1993

P3000.03

12/19/2007

Attachments, Page 122

Attachment 7-2, Page 1

CONFIDENTIAL EXIT INTERVIEW REPORT

FOR INTERVIEWING OFFICIAL

Instructions

Use of this form is optional at the discretion of the Chief Executive

Officer. If exit interviews are conducted, the first part of this

report should be completed by the interviewing official and then given

to the local Human Resource Manager. The Human Resource Manager will

complete the second part of the form. If the separating employee

refuses the interview or cannot be interviewed, the interviewer should

complete as many items as possible using known or available

information and add a comment documenting the lack of a personal

interview.

TO BE COMPLETED BY THE INTERVIEWING OFFICIAL

1. Employee's Name: _______________________________________

2. Primary reason employee is leaving the Bureau of Prisons

1. _______Optional retirement

2. _______Mandatory retirement

3. _______Disability retirement

4. _______Transfer to another government agency

5. _______Resignation

6. _______Resignation in lieu of termination

7. _______Expiration of appointment

8. _______Termination

9. _______Reduction in force

3. Describe in your own words why this employee says he/she is

leaving.

4. Describe in your own words why you think this employee is

leaving.

(This form may be locally copied or BP-S-155(30)

locally reproduced via wordprocessing) SEP 1993

P3000.03

12/19/2007

Attachments, Page 123

Attachment 7-2, Page 2

5. Demographic Data

The interviewer should explain to the employee that we need to collect

some demographic information from him/her so we can examine any trends

in the types of employees leaving the BOP. This information is

essential to determine if any particular groups are leaving the BOP at

a greater rate than other groups. This information may be valuable in

helping to improve the BOP.

Age: _______years

Sex: 1 = male 2 = female _______

Ethnic group: 1 = african american _______

2 = white

3 = hispanic

4 = other (specify_________

Marital status: 1 = single _______

2 = married

3 = separated or divorced

4 = widowed

Children at home? 1 = yes 2 = no _______

Educational level: _______

1 = some high school or technical

training

2 = high school degree or GED

3 = some college

4 = associate's degree

5 = bachelor's degree

6 = some graduate work

7 = graduate degree

Number of prior non-BOP jobs held: _______

(Permanent, full-time jobs only)

Union member: 1 = yes 2 = no _______

6. General comments:

(This form may be locally copied or BP-S-155(30)

locally reproduced via wordprocessing) SEP 1993

P3000.03

12/19/2007

Attachments, Page 124

Attachment 7-2, Page 3

7. Interviewer's name (printed) ______________________________

Title (printed) ______________________________

Institution (printed) ______________________________

Signature and Date: ______________________________

TO BE COMPLETED BY LOCAL HUMAN RESOURCE MANAGER

8. Time with BOP: _____years _____months

9. Time at this institution/location: _____years _____months

10. Date of latest promotion: - -

month day year

11. Time in present position: _____years _____months

12. Social Security Number: - -

13. Job Title: ___________________________________

14. Job Pay Plan/Series: -

15. Grade:

16. Is position supervisory? 1 = yes 2 = no _____

17. Job status: 1 = permanent 2 = temporary _____

18. Work schedule: 1 = full-time 2 = part-time _____

19. Date of separation: - -

month day year

20. Institution: ____________________________ ( )

code

21. Date of last performance rating: - -

month day year

22. Overall rating: 1 = unsatisfactory ____

2 = minimally satisfactory

3 = fully successful

4 = exceeds

5 = outstanding

6 = no rating reported

23. HRM Name (Printed): ___________________________________

HRM Signature and Date: ___________________________________

(This form may be locally copied or BP-S-155(30)

locally reproduced via wordprocessing) SEP 1993

P3000.03

12/19/2007

Attachments, Page 125

Attachment 7-3, Page 1

SENSITIVITY DETERMINATION CHART

64444444444444444444444444444444L44444444444444444444444444444447

5 +)))))))))))))))))), * +)))))))))))))))))))))))), 5

5 * SPECIAL SENSITIVE * * * NON-CRITICAL SENSITIVE * 5

5 * HIGH RISK * * * MODERATE RISK * 5

5.))))))))))))))))))- * .))))))))))))))))))))))))- 5

5 SINGLE SCOPE BACKGROUND * LIMITED BACKGROUND 5

5 INVESTIGATION UPDATE (SBI) * INVESTIGATION 5

5 Director * 5

5 Asst. Directors * 5

5 Regional Directors * 5

5 Witness Security Program * 5

5 -Asst. Admin. Inmate Mon. * 5

5 Section * 5

5 -Chief Inmate Monitoring * 5

5 -Chief Locator Svcs. * 5

5 -Regional CIM Coordinator * 5

5 FEMA Rep. - all locations * 5

5 Positions with access to Top * 5

5 Secret National Security * 5

5 Information * 5

:4444444444444444444444444444444I 5

5 +)))))))))))))))))))), * 5

5 * CRITICAL SENSITIVE * * 5

5 * HIGH RISK * * 5

5.))))))))))))))))))))- * 5

5 FULL FIELD BACKGROUND * 5

5 INVESTIGATION UPDATE * 5

5 * 5

5 ALL LOCATIONS * 5

5 All staff with access to * 5

5 Secret or Confidential * 5

5 National Security * 5

5 Information * 5

5 All ADP-computer positions * 5

5 involved in the direction, * 5

5 planning and design of a * 5

5 system or who may access * 5

5 a system with high risk of * 5

5 damage * 5

5 * 5

5 INSTITUTION LEVEL * 5

5 Warden * 5

5 Associate Wardens * All other positions 5

5 * Executive Assistant * * 5

5 Camp Superintendent * 5

5 Assistant Camp Superintendent * 5

5 Secretaries to Warden/Assoc. * 5

5 Warden/*Camp Superintendent/ * 5

5 Asst. Camp Superintendent* * 5

5 Human Resource Manager * 5

5 Personnel Security Specialist * 5

5 Controller * 5

5 Captain * 5

5 Special Investigative Agent * 5

94444444444444444444444444444444N44444444444444444444444444444448

P3000.03

12/19/2007

Attachments, Page 126

Attachment 7-3, Page 2

SENSITIVITY DETERMINATION CHART (Cont'd)

64444444444444444444444444444444L44444444444444444444444444444447

5 +)))))))))))))))))), * +)))))))))))))))))))))))), 5

5 * CRITICAL SENSITIVE* * * NON-CRITICAL SENSITIVE * 5

5 * HIGH RISK * * * MODERATE RISK * 5

5.))))))))))))))))))- * .))))))))))))))))))))))))- 5

5 FULL FIELD BACKGROUND * LIMITED BACKGROUND 5

5 INVESTIGATION UPDATE * INVESTIGATION 5

5 * 5

5 * 5

5 INSTITUTION LEVEL CONTINUED * 5

5 Computer Specialist * 5

5 *Paralegal Specialist* * 5

5 *Case Management Specialist* * 5

5 *Security Officer (Locksmith)* * 5

5 *Electronics Technician* * 5

5 * All other positions 5

5 REGIONAL LEVEL * 5

5 Deputy Regional Director * 5

5 Executive Assistant * 5

5 Regional Director/Deputy * 5

5 Regional Director Secretary * 5

5 All Regional Administrators * 5

5 * All other positions 5

5 * 5

5 CENTRAL OFFICE LEVEL * 5

5 Director's Office Staff * 5

5 Senior Deputy Asst Director * 5

5 Deputy Assistant Director * 5

5 Executive Assistant * 5

5 Assistant/Senior Deputy Asst/ * 5

5 Deputy Assistant Director's * 5

5 Secretary * 5

5 All Branch Chiefs * 5

5 All Section Chiefs * 5

5 All Personnel Security Staff * 5

5 * All other positions 5

5 TRAINING CENTERS * 5

5 T.C. Directors * 5

5 T.C. Administrators * 5

5 T.C. Director's Secretary * 5

5 Human Resource Managers * 5

5 Personnel Security Specialist * 5

5 Controller * 5

5 Instructional Systems Design * 5

5 Section Chiefs & Special * 5

5 Projects Manager * 5

5 * 5

5 * 5

5 * 5

5 * 5

5 * 5

5 * 5

5 * 5

94444444444444444444444444444444N44444444444444444444444444444448

P3000.03

12/19/2007

Attachments, Page 127

Attachment 7-4

NOTICE TO APPLICANT

As part of the selection process, shortly you will be interviewed

regarding information in your background in order to help determine

your suitability for employment in the Federal Prison System.

Please read the following items and ensure that you understand them.

A member of the Personnel Office staff will be available to answer any

questions you might have in this regard.

1. The Position for which you are applying has been designated as

"Sensitive" for national security purposes.

2. You will be asked a number of questions about yourself and your

past and current behavior to help this agency determine your

suitability and qualifications for the position. These questions are

asked of all applicants of sensitive positions.

3. It is very important that you be truthful and honest in the

interview.

4. You will be asked to sign a statement at the conclusion of the

interview stating that the interview findings are accurate and true.

5. The veracity of many of your responses will be checked through a

urinalysis and through a detailed background investigation. Failure

to disclose facts or concealment of information sought is often more

serious in the employment process than would be the disclosure of

possibly derogatory information.

6. The information from this interview will be used primarily to

determine your fitness for Federal employment. Other uses related to

employment in the Federal government include obtaining a security

clearance, and evaluating qualifications, suitability and loyalty to

the U.S. Government. This information may be furnished to Federal,

state, local or public agencies only in extreme circumstances and only

for purposes authorized by statue or Executive Order. Other than this

exception, this information will be held strictly confidential, used

principally for employment purposes, and not revealed to parents,

relative, past, current, or future employers or anyone other than

those in the Bureau of prisons involved in the selection process.

7. You are not required to supply the information requested in the

interview, but failure to furnish all or part of the information

requested could delay or suspend the processing of your employment and

could result in your not being considered for employment.

I have read the above statements and have received clarification on

any of the items I did not understand.

____________________________________ ___________________

Applicant's signature Date

P3000.03

12/19/2007

Attachments, Page 128

Attachment 7-5, Page 1

AUTHORITY FOR RELEASE OF INFORMATION

TO WHOM IT MAY CONCERN:

I hereby authorize any duly accredited representative of the Federal

Bureau of Prisons bearing this release, or a copy thereof, within one

year of its date, to obtain any information from my medical history.

I hereby direct you to release such information upon request of the

bearer. I understand that the information released is for official

use by the Bureau of Prisons and may be disclosed to such third

parties as necessary in the fulfillment of official responsibilities.

I hereby release any individual, including record custodians, from any

and all liability for damages of whatever kind or nature which may at

any time result to me on account of compliance, or any attempts to

comply, with this authorization. Should there be any question as to

the validity of this release, you may contact me as indicated below.

Signature (Full Name):

Full Name:

Other Names Used:

Parent or Guardian (if required):

Date:

Current Address:

Telephone Number:

Privacy Act Notice

Authority for Collecting Information. E.O. 10450, 5 USC 1303-1305, 42

USC 2165 and 2455, 22 USC 2585 and 2519, and 5 USC 3301.

Purposes and Uses. Information provided on this form will be

furnished to individuals in order to obtain information regarding your

activities in connection with the use of drugs to determine fitness

for Federal employment in a federal correctional institution. The

information obtained may be furnished to third parties as necessary in

the fulfillment of official responsibilities.

Effects of Nondisclosures. Furnishing the requested information is

voluntary, but failure to provide all or part of the information may

result in a lack of further consideration for employment clearance or

access, or in the termination of your employment.

P3000.03

12/19/2007

Attachments, Page 129

Attachment 7-6, Page 1

Date

Name of Contact

Address

Town, State 12345

Dear Sir/Madam:

The person identified below has applied for federal employment, and

has given your name as a personal reference or as a present or former

supervisor or employer.

We must rely on persons such as yourself to help us determine

whether applicants meet the requirements for good character and

unquestionable loyalty to the United States Government. Therefore, we

ask that you complete the form on the back side of this letter.

Please be entirely frank, answering all questions as specifically as

you can. All information given will be kept strictly confidential.

If possible, please return the letter and form within seven days.

An envelope requiring no postage is enclosed for your convenience. If

you should have any questions or concerns, please contact me at (555)

555-5555. Thank you for your assistance in this matter.

Sincerely,

(name)

Human Resource Manager

NAME OF APPLICANT: ______________________________________________

SOCIAL SECURITY NUMBER: _________________________________________

DATE OF BIRTH: __________________________________________________

DATES OF EMPLOYMENT CLAIMED: ____________________________________

TITLE OF JOB APPLYING FOR: ______________________________________

P3000.03

12/19/2007

Attachments, Page 130

Attachment 7-6, Page 2

INQUIRY CONCERNING APPLICANT FOR EMPLOYMENT

PERSON CONTACTED: (NAME) __________________________________________ TITLE: ________________

PLEASE COMPLETE ITEMS 1, 2, & 11-19. IF YOU HAVE BEEN THE APPLICANT’S EMPLOYER OR SUPERVISOR,

ALSO COMPLETE ITEMS

1. HOW HAS YOUR KNOWLEDGE OF THIS APPLICANT BEEN OBTAINED? (CIRCLE) EMPLOYER SUPERVISOR

CO WORKER

2. HOW LONG HAVE YOU KNOWN THE APPLICANT?

3. TITLE OF APPLICANT’S LAST POSITION WITH YOU:

4. HIGH SALARY 5. NUMBER OF EMPLOYEES SUPERVISED?

6. BRIEF DESCRIPTION OF APPLICANT’S DUTIES IN POSITION IDENTIFIED IN ITEM #3:

______________________________

7. EVALUATION OF APPLICANT’S PERFORMANCE

PLEASE CHECK THE APPROPRIATE COLUMN ABOVE AVERAGE SATISFACTORY BELOW AVERAGE

A. DEPENDABILITY

B. ABILITY TO WORK HARMONIOUSLY WITH OTHERS

C. ABILITY TO SUPERVISE OTHERS

D. AMOUNT OF ACCEPTABLE WORK PRODUCED

E. OVER-ALL SKILL IN HIS/HER WORK

F. ATTENDANCE (SEE ITEM 8)

8. IF ITEM 7F IS RATED “BELOW AVERAGE”, IS THE RATING ATTRIBUTABLE TO:

9 TARDINESS 9 UNEXCUSED ABSENCES 9 EXCESSIVE LEAVE REQUESTS

9. IF CIRCUMSTANCES PERMITTED WOULD YOU:

9 EMPLOY OR RE-EMPLOY HIM/HER WITHOUT HESITATION 9 PREFER HIM/HER OVER MOST 9 PREFER

NOT TO HIRE

10. REASON APPLICANT GAVE FOR LEAVING:

11A. TO YOUR KNOWLEDGE HAS HE/SHE EVER BEEN TERMINATED/RESIGNED IN LIEU OF TERMINATION FROM A

JOB BECAUSE OF MISCONDUCT OR UNSATISFACTORY PERFORMANCE? (IF YES, PLEASE COMPLETE 11B.-

11D.)

11B. NAME AND ADDRESS OF EMPLOYER:

11C. REASON FOR TERMINATION OR RESIGNATION:

11D. TO YOUR KNOWLEDGE WS THE APPLICANT NOTIFIED AS TO THE REASON?

PLEASE CHECK YES OR NO FOR THE FOLLOWING QUESTIONS

YES NO

12. DO YOU HAVE ANY REASON TO QUESTION THIS PERSON’S LOYALTY TO THE UNITED

STATES?

13. DO YOU HAVE ANY REASON TO BELIEVE THIS PERSON BELONGS OR HAS BELONGED TO ANY

COMMUNIST OR FASCIST ORGANIZATION, OR TO ANY ORGANIZATION WHICH ADVOCATES

OVERTHROWING OR ALTERING OUR CONSTITUTIONAL FORM OF GOVERNMENT BY FORCE OR

OTHER ILLEGAL MEANS?

P3000.03

12/19/2007

Attachments, Page 131

14. TO YOUR KNOWLEDGE DOES THIS PERSON ASSOCIATE, OR HAS ASSOCIATED WITH ANY

PERSON, WHOSE LOYALTY TO THE UNITED STATES IS QUESTIONABLE OR BELONGS TO ANY

TYPE OF ORGANIZATION DESCRIBED IN #13?

15. DO YOU HAVE ANY KNOWLEDGE OF ANY BEHAVIOR, ACTIVITIES OR ASSOCIATION WHICH

TEND TO SHOW THAT THIS PERSON IS NOT RELIABLE, HONEST, TRUSTWORTHY, AND OF

GOOD CONDUCT AND CHARACTER?

16. DO YOU HAVE ANY INFORMATION INDICATING THIS PERSON’S EMPLOYMENT WOULD BE

AGAINST THE INTEREST OF NATIONAL SECURITY?

17. DO YOU HAVE ANY KNOWLEDGE THAT APPLICANT’S PERFORMANCE ON THE JOB IS

ADVERSELY AFFECTED BY THE USE OF ALCOHOLIC BEVERAGES, NARCOTICS, MARIJUANA,

OR OTHER DRUGS?

18. DO YOU RECOMMEND THIS INDIVIDUAL FOR EMPLOYMENT IN THE FEDERAL GOVERNMENT IN

A SENSITIVE POSITION?

19. USE THIS SPACE AND ADDITIONAL SHEETS IF NECESSARY, TO SUPPLY ANY OTHER PERTINENT

INFORMATION OR EXPLANATION HAVE IN CONNECTION WITH THE ABOVE ANSWERED QUESTIONS.

_______________________________________

FORM COMPLETED BY (SIGNATURE/DATE):

_______________________________________________________________________

P3000.03

12/19/2007

Attachments, Page 132

Attachment 7-7, Page 1

Date

Records Department

Address

Town, State 12345

Dear Sir/Madam:

The individual listed below is being considered for employment as a

(title of position) with the Federal Bureau of Prisons, (name of

facility) in Town, State. Please advise us of any arrest record for:

NAME:

SSN:

DOB:

ARREST RECORD

DATE PLACE CHARGE DISPOSITION

Please check here _____ if you have no record of any arrests.

________________________

Signature/Position Title

If possible, please return this form within seven days. An envelope

requiring no postage is enclosed for your convenience. Thank you for

your continued support of our agency.

Sincerely,

(name)

Personnel Officer

Attachment: Release Authorization

Return Envelope

P3000.03

12/19/2007

Attachments, Page 133

Attachment 7-8

U.S. Department of Justice

Federal Bureau of Prisons

Your Institution Name

Address

(Date)

MEMORANDUM FOR CONNIE DARNE', CHIEF

SECURITY & BACKGROUND INVESTIGATION SECTION

FROM: (Name), Warden

(Institution)

SUBJECT: Certification of Pre-Employment Procedures

This is to certify that the below-referenced individual has been

selected for employment based upon satisfactory pre-employment

screening. The background investigation has been initiated as

documented by the information shown.

Appointee's Name:

Social Security Number:

Date of Birth:

Place of Birth:

OPM Case Number:

Receipt Date:

OPM-FIPC Liaison Officer:

Institution/Employing Office:

Submitting Office Number (SON):

Anticipated EOD Date:

Personnel Staff Contact Person:

Remarks:

P3000.03

12/19/2007

Attachments, Page 134

Attachment 7-9

SAMPLE REQUEST FOR BACKGROUND INVESTIGATION UPDATE

U.S. Department of Justice

Federal Bureau of Prisons

(Institution Letterhead)

(Date)

MEMORANDUM FOR Chief, Security & Background Investigation

Section

FROM: Name/Title

SUBJECT: Background Investigation Update

Attached is the reinvestigation of Name and SSN. Please

update this employee's security file.

Thank you for your assistance.

P3000.03

12/19/2007

Attachments, Page 135

Attachment 7-10, Page 1

WAIVER OF SUBJECT INTERVIEW

I have been given an opportunity to verbally comment on information in

my background investigation and have waived this opportunity. I

understand that the Department of Justice will adjudicate my case on

the information in the background investigation.

Signature Date

Witness Date

P3000.03

12/19/2007

Attachments, Page 136

Attachment 7-11, Page 1

AGREEMENT TO SUBJECT INTERVIEW

I agree to discuss information in my background investigation with

Department of Justice officials and certify that my answers will be

true, complete and correct to the best of my knowledge and belief, and

will be made in good faith.

Signature Date

Witness Date

P3000.03

12/19/2007

Attachments, Page 137

Attachment 7-12, Page 1

SAMPLE NOTICE TO EMPLOYEE - BACKGROUND INVESTIGATION ISSUES

(Name and Address of)

(Employee or Applicant)

Dear (Employee or Applicant):

A number of issues have arisen in connection with your background

investigation which are of concern to the Bureau of Prisons.

Accordingly, the Bureau of Prisons is extending to you the opportunity

to comment on the information in your background investigation upon

which the Bureau of Prisons intends to rely in determining whether to

(extend you or continue your employment with the Bureau of Prisons

and/or continued access to National Security Information. See note).

Enclosed are a statement of your legal rights and several written

questions. Before answering any of the written questions, please read

the statement of your rights, sign and date the statement, and return

it to me immediately in the envelope provided.

If you choose to respond to any of the written questions, please note

that certain answers must be explained in detail. In addition, you

may furnish any other information which you believe should be

considered by the Department of Justice in connection with your

responses to these questions.

If you choose to answer any of the written questions, please complete

the certification appended to the written questions. If you choose

not to answer one or more of the written questions, please also

complete the waiver.

Sincerely,

(Name and Title of BOP official sending the interrogatory)

Enclosures

(Note to Adjudicator: Written interrogatories may be used as follows:

in making an initial employment determination;

in the resolution of derogatory information that surfaces after the

employment decision has been made;

in a determination for authorizing access to National Security

Information.

The letter to the subject and "Notice of Rights" must be constructed

to fit the appropriate circumstance.)

P3000.03

12/19/2007

Attachments, Page 138

Attachment 7-13, Page 1

Notice of Rights to

(Name of Applicant or Subject)

Before you provide responses to any written questions regarding

information contained in your background investigation, you must

understand your legal rights.

1. You have the right to remain silent and not answer any of the

written questions.

2. If you choose to answer only some of the written questions, you

do not waive your right to remain silent with respect to the other

written questions.

3. Any answers to the written questions which you furnish can be

used against you in any proceeding, including criminal proceedings.

4. You have the right to seek advice from a representative before

you answer any written questions.

5. With respect to any unanswered written questions, your

eligibility for employment and/or access to National Security

Information (See Note) with the Bureau of Prisons will be initially

determined solely on the investigative information available to the

DOJ.

6. If you choose to answer the written questions, you must return

your answers to (Name, title and address of BOP official) within 15

working days, unless you request, for good cause shown, and are

granted in writing, an extension not to exceed 15 working days by

(Name of BOP official).

I certify that I have read this statement of my legal rights and

understand it. No promises or threats have been made to me, and no

pressure or coercion of any kind has been applied against me, by any

employee of the United States Government.

________________________________________ ______________________

Signature of Subject Date

________________________________________ ______________________

Witness Date

P3000.03

12/19/2007

Attachments, Page 139

Attachment 7-14, Page 1

SAMPLE INTERROGATORIES

(Narrative)

A number of individuals, who were interviewed by the Office of

Personnel Management in connection with your background

investigation, indicate that you use cocaine on a regular basis. In

addition, one source indicates that you use cocaine occasionally at

parties.

(Request for Comments)

Please set forth your comments, if any, on the above information.

You may use additional sheets of paper, if necessary.

(Introduction to Question)

In addition to any comments above, please answer the following.

(Primary Question)

A. Do you now or have you ever used cocaine?

______ Yes _____ No

If yes, please answer the following. You may use additional sheets

of paper, if necessary.

(Follow-up Questions)

1. How often do you use cocaine?

2. When was the last time you used cocaine?

3. Have you ever sold or distributed cocaine?

4. Have you ever been treated by a doctor for using cocaine?

(Ending Statement)

If you have nothing further to add or wish to furnish additional

information, please check below.

_____ I have nothing further to add.

_____ Please consider the following additional information:

P3000.03

12/19/2007

Attachments, Page 140

Attachment 7-15, Page 1

SAMPLE CERTIFICATION OF RESPONSE TO INTERROGATORIES

ATTENTION - THIS STATEMENT MUST BE SIGNED

Read the following paragraph carefully before signing this statement:

A false answer to any of the written questions may be grounds for

terminating your employment (See Note) in a Bureau of Prisons

position, and may be punishable by fine or imprisonment. All the

information you give will be considered in reviewing your responses

and is subject to investigation. (18 U.S.C. Sec. 1001)

CERTIFICATION - I CERTIFY that all of the statements made on these

pages are true, complete, and correct to the best of my knowledge and

belief, and are made in good faith.

__________________________________________ __________________

Signature (sign in ink) Date

Alternative or Additional Response

I hereby waive the right to answer the above questions not answered by

me. I understand that by my not answering the questions, the Bureau

of Prisons will make an initial determination of my eligibility for

employment in a Bureau of Prisons position based on the investigative

information available.

__________________________________________ ___________________

Signature Date

(Note to Adjudicator: Written interrogatories may be used as follows:

in making an initial employment determination;

in the resolution of derogatory information that surfaces after the

employment decision has been made;

in a determination for authorizing access to National Security

Information.

The letter to the Subject, the "Notice of Rights" and the

Certification must be constructed to fit the appropriate

circumstance.)

P3000.03

12/19/2007

Attachments, Page 141

Attachment 7-16, Page 1

CONTRACTOR PRE-EMPLOYMENT FORM

NAME

ADDRESS

SOCIAL SECURITY NUMBER

Do you know or are you related to anyone who is currently an inmate in

this or any other correctional institution? _____Yes _____No

If yes, please provide names, locations, relationships and describe

any current or anticipated contact with the inmate(s).

Are there any criminal charges currently pending against you?

_____Yes _____No

If so, please provide charge, date arrested, court dates, docket

numbers and any other pertinent details.

Are you now or have you ever been incarcerated or under

correctional supervision (including home detention, probation, work

release, etc.)? _____Yes _____No

If so, please provide dates of incarceration, sentence, location,

charges, current status and any other pertinent details.

CERTIFICATION -- I certify that all of the statements made on these

pages are true, complete and correct to the best of my knowledge and

belief and are made in good faith.

Signature (sign in ink) Date

P3000.03

12/19/2007

Attachments, Page 142

P.S. P3000.03

12/19/2007

Attachment 7-17

STATEMENT OF REGISTRATION STATUS

If you are a male born after December 31, 1959, and are at least 18 years of

age, civil service employment law (5 U.S.C. 3328) requires that you must be

registered with the Selective Service System, unless you meet certain

exemptions under Selective Service law. If you are required to register but

knowingly and willfully fail to do so, you are ineligible for appointment by

executive agencies of the Federal Government.

I certify I am registered with Selective Service System.

I certify I have been determined by the Selective Service System to be

exempt from the registration provisions of Selective Service law.

I certify I have not registered with the Selective Service System.

I certify I have not reached my 18th birthday and understand I am

required by law to register at that time.

Non-Registrants Under Age 26. If you are under age 26 and have not

registered as required, you should register promptly at a United States Post

Office, or consular office if you are outside the United States.

Non-Registrants Age 26 or Over. If you were born in 1960 or later, are 26

years of age or older, and were required to register but did not do so, you

can no longer register under Selective Service law. Accordingly, you are

not eligible for appointment to an executive agency unless you can prove to

the Office of Personnel Management (OPM) that your failure to register was

neither knowing nor willful. You may request an OPM decision through the

agency that was considering you for employment by returning this statement

with your written request for an OPM determination together with any

explanation and documentation you wish to furnish to prove that your failure

to register was neither knowing nor willful.

Privacy Act Statement. Because information on your registration status is

essential for determining whether you are in compliance with 5 U.S.C. 3328,

failure to provide the information requested by this statement will prevent

any further consideration of your application for appointment. This

information is subject to verification with the Selective Service System and

may be furnished to other Federal agencies for law enforcement or other

authorized use in implementing this law.

False Statement Notification. A false statement may be grounds for not

hiring you, or for firing you if you have already begun work. Also, you may

be punished by fine or imprisonment. (Section 1001 of title 18, United

States Code.)

Legal signature of individual (please use ink)

Date signed (please use ink)

P3000.03

12/19/2007

Attachments, Page 143

Attachment 8-1, Page 1

Federal Prison Retirees Association

P.O. Box 161508

Atlanta, Georgia 30321-1508

July 1997

Dear Retiree or Prospective Retiree:

This communication is to advise you, as a retiree or a prospective

retiree of the Federal Bureau of Prisons, of the existence of our

Federal Prison Retirees Association (FPRA). We are organized

nationally to enable us to maintain ties with former co-workers, to

promote continued fellowship, and to provide service in certain ways.

We publish an Annual Directory of Association Members, and we publish

six newsletters each year - January, March, May, July, September, and

November. We have an annual meeting at a central point for all of our

members, with information about this meeting published in our

newsletter.

Annual dues are $10 for a retiree and $6 for a surviving spouse of a

retiree. The annual dues payment covers a calendar year period of

January 1 through December 31, payable on or before January 1. Also,

due to the Privacy Act of 1974, we cannot list your name in our

Directory, only available to members of the FPRA, without your written

approval.

If you would like to join the FPRA, complete the enrollment form

below, enclose the required annual fee of $10 as a retiree, or $6 as a

surviving spouse of a retiree, and return it to the address listed

below.

FEDERAL PRISON RETIREES ASSOCIATION

P.O. Box 161508

Atlanta, GA 30321-1508

New/_/Renewal/_/Retiree membership for one year, $10 enclosed

New/_/Renewal/_/Survivor (of a retiree) membership for one year,

$6 enclosed

NAME:______________________ ______________________

(Type or print clearly (Spouse's name)

ADDRESS:______________________ Retired from:_______________

(name of institution)

______________________________ Date of retirement:_________

______________________________ Date of birth:______________

Under the provisions of the Privacy Act of 1974, the Federal Prison

Retirees Association (FPRA) has my permission to publish my name and

address in organization publications. /_/Yes /_/No

______________________________ _______________________

(Signature) (Date)

P3000.03

12/19/2007

Attachments, Page 144

Attachment 9-1, Page 1

STAFF UNIFORM ALLOWANCES

Effective February 14, 1991, the annual allowances for various

uniforms prescribed by the Bureau of Prisons for use in performance of

official duties are as follows:

Work Uniform $300 per year

Food Service Uniform $300 per year

Nurse Uniform $400 per year

Dress Uniform $400 per year

Recreation Uniform/ $400 first year/$300 per year

Staff Training Academy in subsequent years

Instructor Uniform

NOTE: Correctional Security Officers and other Correctional

Services employees who are authorized to wear both the work

and dress uniforms are entitled to the full amount of the

dress uniform allowance, but are not entitled to the work

uniform allowance.

Employees exempt from wearing a uniform under provisions of

Paragraph 10 are not authorized a uniform allowance.

P3000.03

12/19/2007

Attachments, Page 145

Attachment 9-2

AUTHORIZED STAFF UNIFORMS

Dress Work Food Recreation Nurse

Service

M F M F M F M F M F

BLAZER, NAVY BLUE X X

TROUSERS, MEDIUM GRAY X

SLACKS OR SKIRT, MEDIUM GRAY X

SHIRT, NICKEL GRAY X X

TROUSERS, NICKEL GRAY X X

SKIRT, NICKEL GRAY /1 X

JACKET, NICKEL GRAY X X

TROUSERS, NAVY BLUE X X

SLACKS, NAVY BLUE X/5 X/5 X X

SHORTS, NAVY BLUE /1 X/5 X/5 X X

SHIRT, WHITE X X

SHIRT, WHITE OR LIGHT BLUE X X

KNIT SHIRT, LIGHT BLUE X X

SWEATER/WINDBREAKER /2 X X X X X X X X X X

DRESS OR PANTSUIT, WHITE X

TROUSERS AND SHIRT, WHITE X

SHOES, BLACK (S) X X X X X X X X

SHOES, WHITE X X

SOCKS, BLACK X X/3 X X/3 X X

P3000.03

12/19/2007

Attachments, Page 146

Dress Work Food Recreation Nurse

Service

M F M F M F M F M F

SOCKS, WHITE X/5 X/5 X X X X/4

SOCKS, NAVY BLUE X X

NECKTIE, MAROON X X X/1 X/1

CROSSTIE, MAROON X X/1

BELT, BLACK X X X X X X

BALLCAP, NAVY BLUE X X X X X X

SHIRT, WHITE [FLETC ONLY] X X

(NOT MONOGRAMMED)

POLO SHIRT, MAROON PULL-OVER X X

[FLETC ONLY]

SWEATSHIRT W/BOP EMBLEM, NAVY X X

BLUE [FLETC ONLY]

(S) Safety toe shoes must be worn in areas identified as foot hazard areas

/1 Optional, at the discretion of the Chief Executive Officer

/2 At the employee's option

/3 Neutral color hose or pantyhose optional

/4 White or neutral color hose or pantyhose optional

/5 Restricted to FLETC instructors only