Applicant will submit all documents back to the company.

Transcription

1 USPS New Hire Packet Approximate time to complete: 1 hr Due Date: within 24 hours of receiving this packet. Complete then scan or fax back to the company immediately. Company will review your packet, if everything is correct the company will let you know when to mail your packet. If you cannot meet the due date call your Hiring Manager. Contents in packet: 1. Cover page 2. Authorization & release Form C 3. Personnel Questionnaire Form 2025 (2 pages) 4. Finger print card instructions, Passport size photo instructions, MVR instructions. Applicant will submit all documents back to the company. APPLICANT MUST READ: Applicant is responsible for USPS screening process costs. There will be fees for finger printing, passport size photos, and providing a current MVR dated within the last 30 days of your application. Applicant is responsible for reading the instructions on each document and submitting the required forms on time. Contact the company with any questions. Any section that applies to you must be completed legibly and in black ink. exceptions. Your USPS screening packet will not be processed until it is 100% complete. Incomplete packets may delay your pay N. Maize Rd. Maize, KS Fax:

2 Authorization and Release Background Investigation (USPS Contractors and Employees of Contractors) Applicant: Carefully read the following information before you complete and sign this form. Privacy Act Statement: The collection of this information is authorized by 39 USC 404, 18 USC 3061, and 5 USC, App. 3. This authorization will be used to obtain information from organizations and individuals pertaining to your character, personal history, credit standing, educational claims, current or prior employment, military service, and other information which may be relevant and necessary to determine your fitness and suitability to perform services under contract with the Postal Service, including a security clearance and evaluation of your loyalty to the United States. This authorization does not consent to the collection of information by the Postal Service except as otherwise permitted by law. r does it waive any remedy you may have against the Postal Service in the event of a violation of the Privacy Act or other rights established by law. As a routine use, this information may be disclosed to an agency for which information is requested in the course of a background check; to an appropriate government agency, domestic or foreign, for law enforcement purposes; where pertinent, in a legal proceeding in which the USPS is a party or has an interest; to a government agency in order to obtain information relevant to a USPS decision concerning employment, security clearances, contracts, licenses, grants, permits or other benefits; to a government agency upon its request when relevant to its decision concerning employment, security clearances, security or suitability investigations, contracts, licenses, grants or other benefits; to a congressional office at your request; to an expert, consultant, or other person under contract with the USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and Budget for review of private relief legislation; to an independent certified public accountant during an official audit of USPS finances; to an investigator, administrative judge or complaints examiner appointed by the Equal Employment Opportunity Commission for investigation of a formal EEO complaint under 29 CFR 1614; to the Merit Systems Protection Board or Office of Special Counsel for proceedings or investigations involving personnel practices and other matters within their jurisdiction; and to a labor organization as required by the National Labor Relations Act; to an appropriate foreign or international law enforcement agency, an organization, or individual for investigative or prosecutorial purposes, to assist in crime prevention or detection, to obtain information relating to a pending investigation, trial or hearing, to obtain the cooperation of a witness or informant or to notify of the status of the case; to a party or his attorney to discuss settlement, plea bargaining, or discovery proceedings; to an agency or individual concerned with maintenance, extradition, or release of a person held in custody; to a foreign country pursuant to an international treaty, conventions, or executive agreement; to the public, news, media trade associations or organized groups if it is information of interest on accomplishments of the Postal Service or its employees; to a foreign country when apprehending and/or returning a fugitive to a jurisdiction seeking return; to American Insurance Association Index System members if it is information relating to accidents or injuries. Completion of this form is voluntary; however, if consent to obtain this information is not given, it may have an adverse effect on your opportunities to perform services under contract with the USPS. Applicant s Name (Last, First, Middle) Mailing Address Date of Birth (Month, Day, Year) Home Phone Number ( ) This constitutes my consent and authorization to the disclosure or furnishing of any relevant and necessary information or records to any duly authorized official of the USPS by any person, corporation, agency, or association concerning my character, personal history, credit standing, educational claims, current or prior employment, military service, and other information which may be relevant and necessary to determine my fitness and suitability to perform services under contract with the USPS. This authorization is executed with full knowledge and understanding that the USPS will take measures to protect the aforementioned information against unauthorized disclosure to any parties not having a legitimate need for it in the discharge of official business of the United States, or its agencies and instrumentalities. I hereby RELEASE the aforementioned persons, corporators, agencies, associations and their employees, agents and representatives from any and all liability for damages resulting from a decision by the USPS not to contract for my services on account of compliance with this authorization, except for any damages resulting from knowingly providing false or misleading information or records about me. A copy of this authorization shall be as effective and valid as the original. This authorization shall be valid for 12 months from the date it is signed. Date Signed Signature of Applicant PS Form 2181-C, April 1996

3 Contract Personnel Questionnaire Prepare in duplicate. Type or print all responses. If answer is, state so. Attach sheets if more space is needed. Privacy Act Statement: Your information will be used as a basis for an investigation to determine your fitness and suitability for contractual services to the U.S. Postal Service (USPS ). Collection is authorized by 39 U.S.C Providing the information is voluntary, but if not provided you may be denied access to Postal Service premises, denied access to the mail, or denied participation under a USPS contract. We may disclose your information as follows: in relevant legal proceedings; to law enforcement when the USPS or requesting agency becomes aware of a violation of law; to a congressional office at your request; to entities or individuals under contract with USPS; to entities authorized to perform audits; to labor organizations as required by law; to federal, state, local or foreign government agencies regarding personnel matters; to the Equal Employment Opportunity Commission; to the Merit Systems Protection Board or Office of Special Counsel. 1. Print Your Full Name (Last, First, Middle Name) 2. Print Your Mailing Address (Include Apartment/Suite Number) 3. City, State and ZIP+4 Code 4a. Home Telephone Number (Include Area Code) 4b. Work Telephone Number (Include Area Code) 5. List Other Names Used. (i.e., maiden name, names by former marriages, names changed legally or otherwise, aliases, nicknames. Specify which and dates used.) 6. Social Security Number (SSN) 7. Date of Birth (MM/DD/YYYY) 8. Place of Birth (City and State/Country) 9. Sex Male 10. Type of Screening (Check one) 11. Are You Presently a Highway Contract Driver? (If, include Contract Number and Termini.) Contractor X Contractor s Employee Sub-Contractor ADP Other 13. Contractor s Name and Mailing Address 12. Highway Contract Number and Termini (If applicable) Marroquin Express, Inc 6045 N. Maize Rd. Maize, KS Have You Had a Security Screening by USPS or Other Federal Agencies Within the Last Year? Agency: 15. Dates and Places of Residence. (If actual places of residence differ from the mailing addresses, furnish and identify both. Begin with present residence and go back for the past five years.) Female Number and Street City State ZIP+4 Code 16. Employment. (List ALL periods of employment for the past five years starting with your present employment. Include dates when unemployed. Give name under which employed if different from name now used.) Employer s and Supervisor s Names Employer s Address (City, State, Zip+4Code) Occupation Reason for Leaving Your Name During Period of Employment 17a. Are You a United States Citizen? 17c. Provide Alien Registration Number if not a United States Citizen 17b. Are You a Citizen of American Samoa or Any Other Territory Owing Allegiance to the United States? 18a. Do You Have a Valid License? (Driver/Chauffeur) If, include License Number, State, and Expiration Date. 18b. Commercial Driver s License PS Form 2025, March 2012, (Page 1 of 2) PSN (Continued on Page 2)

4 19a. Are you a male born after December 19. Your Selective 31, 1959? If, go to 20a. If, Service Record go to 19b. 19c. Registration Number 19d. Legal Exemption Explanation 19b. Have you registered with the Selective Service System? If, provide your registration number. If, show the reason for your legal exemption. 20a. Military Service (Past or Present). (If, complete Items 20b, 20c, 20d, 20e, and 20f.) 20b. Dates of Service 20c. Branch of Service (Army, Navy, Air Force, Marines, etc.) 20d. Serial Number (If none, provide Grade or Rating at time of separation) 20e. Were You Discharged from the Military Service Under Honorable Conditions? (If your discharge was changed to honorable or general by a Discharge Review Board, answer. If you received a clemency discharge, answer.) If, enter the date and type of discharge you received in the blocks below. Discharge Date Type of Discharge 20f. While in Military Service, Were You Ever Convicted by Court Martial? Court Martial Date (MM/DD/YYYY) Place (City and State/Country) Charge Disposition 21a. Have You Ever Been Convicted of, or Forfeited Collateral, for Any Felony/Misdemeanor Violation (Except Traffic Violations)? (Generally, a felony is defined as any violation of law punishable by imprisonment of one year or longer.) 21b. During the Last 10 Years Have You Forfeited Collateral, Been Convicted, Been Imprisoned, Been on Probation, or Been on Parole for any Violation of Law? (Do not include violations reported in question 21a.) 21c. Have You Ever Been Convicted of, or Forfeited Collateral for Any Assaults, Firearms or Explosives Violations? 21d. Are You w Under Charges for Any Violation of Law? If any answers to 21a - 21d are, provide date, place, court location, charge, and disposition on an attached sheet. 21e. Are You Delinquent on any Federal Debt? (Include delinquencies arising from Federal taxes, overpayment of benefits, or other debts to the U.S. Government plus defaults on Federally guaranteed or insured loans such as student and home mortgage loans.) Date Place (City and State) Court Charge Action Taken If necessary, attach additional sheets. 22. In the Past 5 years, Have You Been Convicted of any Traffic Violations (Other Than Parking) or Currently Have Charges Pending? (If, complete information below.) Date Place (City and State) Court Charge Action Taken If necessary, attach additional sheets. Check Here if Your Driver s Abstract from Department of Motor Vehicles is Attached. Warning Review this form carefully to ensure you have answered all questions fully and correctly. Failure to answer all questions may result in your being denied access to mail and/or Postal Service premises. A fine not to exceed $250,000 or imprisonment of not more than five years or both is provided by law (18 U.S.C. 1001) for making a false statement or concealing any material fact on this Questionnaire. Certification I certify that the statements made by me on this questionnaire are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. Applicant s Signature I attest I have advised the Applicant to truthfully complete this Questionnaire, and the Applicant has passed the Drug Screening Test (If applicable, provide documentation). Contractor s Signature (Sign and print name) Telephone Number (Include area code) For Use of Postal Service Official Responsible for Reviewing for Completeness and Legibility. (See Administrative Support Manual , Contractor Clearance, for complete instructions.) USPS Official Signature (Sign and print name) Telephone Number (Include Area Code) Organization, City, State, and ZIP+4 Code PS Form 2025, March 2012 (Page 2 of 2)

5 Applicant- read entire form to ensure you do not miss anything. Finger Print Instructions- Applicants Outside The State Of Kansas 1. Contact your local police department ahead of time for fingerprint processing instructions for USPS Screening. You are responsible for making your own appointment and asking if they will provide you TWO finger print cards. If they will not provide finger print cards notify the company so we can mail you the cards. 2. Return both cards with the rest of the USPS new hire packet. Finger Print Instructions- Applicants In Wichita, KS Wichita, KS ONLY (ask company for fingerprint cards if NOT included here) 1. Call Monday, Wednesday, or Friday between 1-3pm. 2. Call and ask for Finger Printing Department. 3. When appointment is made take $20 CASH, both finger print cards, and photo ID. 4. Return both cards with the rest of the USPS new hire packet. Location: 2235 W 37 th St rth Wichita, KS Passport Size Photo Instruction- All Applicants 1. Visit your nearest Walgreens or Photo Department and request passport size photos. You will automatically receive 2 photos. Approximate cost is $ Return both photos with the rest of the new hire packet. MVR Instructions- Applicants Outside Of The State Of Kansas 1. Contact your local DMV to pick up your MVR OR visit the state DMV website to print your MVR if this option is available. 2. Return the original MVR with the rest of the USPS new hire packet. MVR Instructions- Applicants In the State Of Kansas Kansas ONLY 1. Sign here to authorize Marroquin Express to pull your current MVR online on your behalf. A copy will be kept in your employee file. 2. The current price is approximately $8.70. Price is determined by the State. 3. The company will automatically deduct the cost from your first paycheck. 4. Submit this signed document with the rest of your new hire packet. Disclaimer: The above requests are requirements from the United States Postal Service. You will be hauling Federal Mail and therefore require a Federal screening process. Marroquin Express thanks you for your cooperation with their requests N. Maize Rd. Maize, KS Fax: