Form 511, 2015, Bureau Of Reclamation Pre-Appointment Background Check List For Critical Sensitive Positions
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4SLE 01-01
Appendix B
Reclamation Manual
Directives and Standards
Form B1. Bureau of Reclamation Request for Waiver of Pre-Appointment Investigative
Requirement for a Critical-Sensitive Position Approval Form (Non-Law
Enforcement).
U.S. DEPARTMENT OF THE INTERIOR
REQUEST FOR WAIVER OF PRE-APPOINTMENT INVESTIGATIVE REQUIREMENT
FOR A CRITICAL-SENSITIVE POSITION (Non-Law Enforcement)
ORIGINATING MANAGEMENT OFFICE (where candidate is to be appointed)
CANDIDATE’S NAME
PROPOSED POSITION TITLE
ORGANIZATION
PROPOSED EOD (DATE)
A waiver of the pre-appointment investigative requirement is being requested for emergency reasons
and such action is necessary in the national interest. A justification for this request is attached. If
approved, I will ensure that the individual will not have access to any classified national security
information prior to the granting of a national security clearance (if a requirement of the position).
Forms required for the investigation were submitted to the bureau/office security officer on ____(date).
IMMEDIATE SUPERVISOR SIGNATURE & DATE
PRINTED NAME
HIGHER LEVEL SUPERVISOR SIGNATURE & DATE
PRINTED NAME
SERVICING HUMAN RESOURCES OFFICER (or designee)
Based on my review of the individual's previous employment record and knowledge of this candidate's
background, there appears to be no derogatory information which would preclude employment in a
Critical-Sensitive position pending completion of the required investigation.
SIGNATURE & DATE
PRINTED NAME
RECLAMATION SECURITY OFFICER (or designee)
(send to 84-45000)
The results of the
m andatory
checks listed in 441 DM 4 are attached.
U
U
SIGNATURE & DATE
PRINTED NAME
HEAD OF BUREAU – APPROVAL (Delegated to the SSLE Director or designee)
SIGNATURE & DATE
PRINTED NAME
ATTACHMENTS: (1) Justification for this Request, & (2) Results of Mandatory Checks (DI-1990)
ORIGINAL: EMPLOYEE'S OPF
cc: EMPLOYEE'S SECURITY FILE - 1
Modification B1 of DI-1912
(511) 02/02/2015
Page B1
SUPERSEDES SLE 01-01 (363) 09/29/2009 and minor revisions approved 09/29/2010
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