(Name of U. S. Government - DEA

[Pages:1]CORPORATE LETTERHEAD

NOTICE OF SUITABILITY OR FITNESS DETERMINATION FOR

A POSITION OF PUBLIC TRUST

DATE:

A favorable suitability or fitness determination was made by the (Name of U. S. Government Agency) is hereby verified for the following individual: Full Name: SSN: Place of Birth: Date of Birth: Type of Background Investigation: Completion Date of Background Investigation: Background Investigation Conducted By: Access Level: Adjudicating Agency's Personnel Security Point of Contact and Telephone Number: DEA Contract/Task Order/Purchase Order/Agreement Number: Candidate's Labor Category: Please contact me at (telephone number) if you have any questions or need additional information. Sincerely, (Signature) Typed Name of Corporate or Facility Security Officer (as applicable)

(ISR 8/31/10)

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