**CONTRACTOR PRE-PROCESSING INVESTIGATION VERIFICATION**

+-----------------------+----------------------+----------------------+
| Applicants' Last Name | Applicants' First    | Applicants' Middle   |
|                       | Name                 | Name                 |
|                       |                      |                      |
|                       |                      |                      |
+-----------------------+----------------------+----------------------+
| Applicants' Social    | Applicants' Date of  | Company Name         |
| Security Number       | Birth                |                      |
|                       |                      |                      |
|                       |                      |                      |
+-----------------------+----------------------+----------------------+

**Prior to submitting the above applicants' personnel security clearance
request to Sandia National Laboratories do the following:**

**Conduct the following checks, as appropriate, to establish the
individual's job qualifications and suitability:**

-   A credit check;

-   Verification of a high school degree or diploma or a degree or
    diploma granted by an institution of higher learning within the past
    5 years;

-   Contacts with listed references;

-   Contacts with listed employers for the past 3 years (excluding
    employment of less than 60 working days duration, part-time
    employment, and craft/union employment); and

-   Local law enforcement checks when such checks are not prohibited by
    state or local law, statute or regulation.

**Verify the applicant is a U.S. citizen by viewing one of the following
documents:\
**

-   Original or certified U.S. birth certificate.

-   U.S. Passport, current or expired.

-   Record Of Military Processing-Armed Forces of the U.S.- (DD Form
    1966), provided it reflects that the individual is a U.S. citizen.

-   For an individual claiming citizenship by naturalization, a
    certificate of naturalization showing the individual's name is
    required.

-   For an individual claiming citizenship acquired by birth abroad to a
    U.S. citizen, one of the following (showing the individual's name)
    is required:

    -   A Certificate of Citizenship issued by the Immigration and
        Naturalization Service;

    -   A Report of Birth Abroad of a Citizen of the U.S. of America
        (Form FS 240); or

    -   A Certificate of Birth (Form FS 545 or DS 1350).

**Contractors to Sandia National Laboratories should submit applicants
whose background offers the best prospect of obtaining a security
clearance. The following are security clearance disqualifying criteria,
which are not all inclusive and may vary depending on access
requirements:**

-   The applicant is, or is suspected of being a terrorist.

-   There is an outstanding warrant against the applicant.

-   The applicant has deliberately omitted, concealed, or falsified
    relevant and material facts from any *Questionnaire for National
    Security Positions* (SF-86), *Questionnaire for Non-Sensitive
    Positions* (SF-85), or similar form used in the determination of
    eligibility for a DOE security badge.

-   The applicant has presented false or forged identity source
    documents.

-   The applicant has been barred from Federal employment.

**The following may suspend the processing of a personnel security
clearance request:**

-   The applicant is currently awaiting a hearing or trial;

-   The applicant has been convicted of a crime punishable by
    imprisonment of 6 months or longer; or is awaiting or serving a form
    of preprosecution probation, suspended or deferred sentencing,
    probation, or parole in conjunction with an arrest or criminal
    charges against the individual for a crime that is punishable by
    imprisonment of 6 months or longer.

I, the undersigned Company Official, verify that a pre-processing
investigation has been performed for the above applicant.

  ------------ ---------------- -- ---------------------------- -- ---------
                                                                        

  Name                             Signature                       Date
  *(Print)*                                                        

  **OFFICIAL   This form should                                    
  USE ONLY**   be protected as                                     
               Official Use                                        
               Only upon                                           
               completion.                                         
  ------------ ---------------- -- ---------------------------- -- ---------

+-----------+----------------------------------------------------------+
| **        | All records and information pertaining to clearance      |
| Records** | applicants, including copies of security forms and       |
|           | information collected from the conduct of pre-processing |
| **Main    | checks,                                                  |
| tenance** |                                                          |
|           | must be protected against unauthorized disclosure        |
|           | \[Privacy Act of 1974                                    |
|           |                                                          |
|           | (5 U.S.C 552a)\]. Information collected by the           |
|           | contractor for clearance processing must not be used by  |
|           | the contractor for any purpose other than that for which |
|           | it is intended and must not be provided to               |
|           | non-contractor employees or any other entity or          |
|           | organization.                                            |
+-----------+----------------------------------------------------------+
| **Su      | Sign and submit SF 2730-CIV, Contractor Pre-Processing   |
| bmittal** | Investigation Verification Form to Sandia National       |
|           | Laboratories with the following personnel security       |
|           | clearance request forms:                                 |
|           |                                                          |
|           | -   [SF                                                  |
|           |     7643-CEC](ht                                         |
|           | tp://www-irn.sandia.gov/corpdata/corpforms/7643cec.doc), |
|           |     Contractor/Consultant Badge/Clearance Request        |
|           |                                                          |
|           | -   [DOE F                                               |
|           |     472.1C](ht                                           |
|           | tp://www-irn.sandia.gov/corpdata/corpforms/7643doe.dot), |
|           |     Clearance Request/Recertification/Suitability        |
|           |                                                          |
|           | -   [HSPD-12](http                                       |
|           | ://www-irn.sandia.gov/corpdata/corpforms/doeHSPD12.doc), |
|           |     HSPD-12 Badge Request                                |
+-----------+----------------------------------------------------------+

+-----------+----------------------------------------------------------+
| **Sandia  | **Sandia National Laboratories/California**              |
| National  |                                                          |
| Lab       | Visitor Control Department\                              |
| oratories | Carol James\                                             |
| C         | PO Box 969\                                              |
| ontacts** | Mail Stop 9113\                                          |
|           | Livermore, CA 94551-9988                                 |
|           |                                                          |
|           | Phone: (925) 294-2061                                    |
|           |                                                          |
|           | Fax: (925) 294-1330                                      |
|           |                                                          |
|           | **Sandia National Laboratories/New Mexico**              |
|           |                                                          |
|           | Personnel Security Department\                           |
|           | Jennifer Romero\                                         |
|           | PO Box 5800\                                             |
|           | Mail Stop 1475\                                          |
|           | Albuquerque, NM 87185-1475                               |
|           |                                                          |
|           | Phone: (505) 845-8270                                    |
|           |                                                          |
|           | Fax: (505) 844-9739                                      |
+-----------+----------------------------------------------------------+
| **Ref     | DOE N 206.4, Personal Identity Verification\             |
| erences** | DOE M 470.4-5, Personnel Security *(Attachment 2,        |
|           | Contractors Requirements Document)*                      |
+-----------+----------------------------------------------------------+