New Hire Application for Transportation - PDF by jbl89207


New Hire Application for Transportation document sample

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    Transportation Worker Identification Credential (TWIC)
                    New Hire Statement
                          (In accordance with 33 CFR 105.257 (b)(1))

I, ____________________________, as part of my employment duties, I am required to
have unescorted access to secure areas of ___(Name of Facility)____in which a
Transportation Worker Identification Credential (TWIC) is required; I am now, or I am
applying to be, a credentialed transportation worker in accordance with 49 CFR 1572.

The information I have provided on my TWIC application is true, complete, and correct,
to the best of my knowledge and belief, and is provided in good faith. I understand that
a knowing and willful false statement, or an omission of a material fact on my TWIC
application, can be punished by fine or imprisonment or both (see section 1001 of Title
18 United States Code), and may be grounds for denial of a Transportation Worker
Identification Credential and termination of employment with ___(Name of Facility)___.

I acknowledge that if the Transportation Security Administration determines that I pose
a security threat, my employer, ___(Name of Facility)____, will be notified. If TSA or
other law enforcement agency becomes aware of an imminent threat to ___(Name of
Facility)____, TSA may provide limited information necessary to reduce the risk of injury
or damage to ___(Name of Facility)____. _____Initials

    (Print full name of New Hire)

______________________________                                   _______________
      (Signature of New Hire)                                          (Date)

______________________________                                   _______________
       (Signature of FSO)                                             (Date)

______________________________                                   _______________
  (Signature of Facility Manager)                                     (Date)



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