First name MI Last name

Name of requestor: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Project:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Location of field work:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Purpose of use:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Start Date Return date Date of request

Time frame of use: \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Firearm(s) used: \_\_\_ Personal \_\_\_ USGS

Serial Numbers Qualified to carry?

Type of Firearm: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Verification \_\_\_\_ Current training complete

of training

(yes/no) \_\_\_\_ Current Domestic Violence Certificate on file

I certify that the following employee has a need for the use of a
firearm in connection with official duties and that he/she has met the
training requirements outlined in the USGS Occupational Hazards and
Safety Procedures Handbook (445-2-H), Chapter 19.

Supervisor\'s Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Supervisor\'s Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date:\_\_\_\_\_\_\_\_\_\_\_\_\_

Prior to \_\_\_\_ Signed copy of Certificate of Need on file
Requestor\'s

Issuing Firearm Initials

(yes/no) \_\_\_\_ Safety lock issued

\_\_\_\_\_\_\_\_\_\_

\_\_\_\_ Advised to return within 30 days of "Time

Frame of Use" and in good working order

Additional copies shall be forwarded to and retained by the employee's
supervisor.

Memorandum

To: All Employees Issued Government-Owned Firearms or Ammunition

All Employees Authorized to Possess Firearms or Ammunition

From: DOI/USGS Management

Subject: Disqualification for Misdemeanor Convictions for Domestic
Violence

There has been a recent change in the law pertaining to possession of
firearms or ammunition. On September 30, 1996, 18 U.S.C. § 922(g)(9)
took effect, making it a felony for anyone who has been convicted of a
misdemeanor crime of domestic violence to possess a firearm or
ammunition. A "misdemeanor crime of domestic violence" is defined
generally as any offense---whether or not explicitly described in a
statute as a crime of domestic violencewhich has as its factual basis
the use or attempted use of physical force, or the threatened use of a
deadly weapon, committed by the victim\'s current or former domestic
partner, parent, or guardian. The term "convicted" is generally defined
in the statute as excluding convictions that have been expunged or has
been set aside, or for which the individual has received a pardon. A
copy of the statute is attached. Please review it.

This provision applies to persons who have been convicted at any
timeeven prior to the effective date of the law. There is no exemption
for law enforcement officers or agents, or for any official government
use. If you ever have been convicted of a misdemeanor crime of domestic
violence within the meaning of the statute, continued possession of any
firearm or ammunition, whether Government-issued or privately-owned, is
grounds for felony criminal penalties, including the sentence of
imprisonment of up to ten years and a fine of up to \$250,000. Such
unlawful possession of firearms or ammunition also may be grounds for
administrative disciplinary action, up to and including dismissal.

If you are affected by this statute:

\(1\) You may not possess ANY firearms or ammunition; and

\(2\) You must return any Government-issued firearm or ammunition to
your immediate supervisor.

Since the statute makes it illegal for you to possess any firearm or
ammunition, any previously issued authorization to possess a firearm or
ammunition is revoked. A conviction "within the meaning of the statute"
means those convictions that have not been expunged or set aside, or for
which the individual has not received a pardon.

The withdrawal of authority to use or possess firearms and ammunition,
based on a conviction for a misdemeanor crime of domestic violence, is
permanent, with one exception: a future pardon or expungement of the
conviction under applicable state law will cancel the firearms ban,
unless the pardon or expungement expressly maintains the ban. You may
seek expungement or pardon only at your own expense and on your own
time.

Unfortunately, another avenue of relief has been foreclosed by
legislation. Under 18 U.S.C. § 925 (c), the Secretary of Treasury is
authorized to grant relief to anyone prohibited from possessing firearms
under 18 U.S.C. §922. Since 1922, however, the Treasury Department has
been prohibited in annual appropriations acts from using appropriated
funds to consider applications for relief for individuals. The Omnibus
Appropriations Act for Fiscal Year 1997, Public Law 104-208, retains
this prohibition.

Attached to this memorandum is a qualification inquiry (see Appendix
29-2 in this Handbook), which you must complete and return to your
immediate supervisor within ten (10) working days of receipt. If you
have any questions, you may contact your immediate supervisor, your
union representative, or a private attorney.