B—Information on the proposed organization
1. Legal name (required)
2. Business name (if different from legal name)
3. Mailing address (required)
4. Civic (physical) address
6. Organization fax number
8. Title of contact person (required)
9. Telephone number of contact person (required)
10. Email address of contact person (required)
11. Preferred language of correspondence (required)
D—Reason for the private sector organization screening request (select those that apply, at least one is required)
Provide the contract or RFP number (required)
Provide the name of the program or project (required)
Provide the name of the Crown project (required)
Provide details (required)
E—Information on security requirements
To gain access to protected or classified information, assets and work sites, personnel must have the respective reliability screening or security clearance.
A reliability status screening is required to access Protected A, B and C, and foreign restricted information, assets and work sites.
A security clearance at the level of information, assets and work sites to be accessed is required to access Confidential, Secret and Top Secret. In the case of North Atlantic Treaty Organization (NATO), a NATO security clearance at the level of the classified information, assets or work sites to be accessed is required prior to access. A security clearance also entitles a person to access protected information and assets on a need-to-know basis.
Learn more about reliability status and personnel security clearances in Chapter 4: Personnel screening of the Contract Security Manual.
1. Indicate level(s) of personnel security screening required (select those that apply, at least one is required)
2. Will the proposed organization be required to store protected or classified information or assets? (required)
3. Will the proposed organization be required to store protected or classified communications security (COMSEC) information or assets? (required)
F—Information on the procurement officer or project manager requesting private sector organization screening (if different from section G )
To be completed by the procurement officer or project manager. If this is the same individual as the approved source, leave this section blank and skip to section G.
1. Surname, given name
2. Title or rank
3. Department, agency or organization
4. Branch or directorate
5. Mailing address
6. Email address
7. Telephone number
8. Fax number
9. Signature of procurement officer or project manager (sign by hand)
Date (yyyy-mm-dd)
G—Information on the approved source requesting the private sector organization screening
The approved source must complete this section of the form.
1. Surname, given name (required)
2. Title or rank (required)
3. Department, agency or organization (required)
4. Branch or directorate (required)
5. Mailing address (required)
6. Email address (required)
7. Telephone number (required)
8. Fax number
9. Signature of approved source (sign by hand)
Date (yyyy-mm-dd) (required)
