Pre-Employment Certification - Northrop Grumman



Government/Military Experience QuestionnaireForm C-411 (9-19)* Page 1 of 2NAME FORMTEXT ?????CURRENT EMPLOYER FORMTEXT ?????CURRENT POSITION FORMTEXT ?????Note: All references to Northrop Grumman herein are intended to include Northrop Grumman Corporation, all entities with Northrop Grumman in their name, and all entities with Alliant Techsystems, ATK, or Orbital Sciences in their name, and other Northrop Grumman entities. If you need additional information on terminology, please see the attachment at the end of the form.Please answer the first four questions, then follow the instructions below. 1. In the past three years from today’s date, have you been employed by a private sector organization/company & personally participated in a bid, proposal, capture, or competition for any program(s) in which Northrop Grumman may be/has been a competitor? FORMCHECKBOX Yes FORMCHECKBOX No2. Are you currently employed or have you been employed in the past five years by a state or local government entity (other than temporary summer or part-time positions, e.g. lifeguard, EMT, not involved in government contracting/procurement activities)? FORMCHECKBOX Yes FORMCHECKBOX No3. In the past five years, have you worked for the U.S. Government in a SETA, A&AS, Special Government Employee, or similar capacity, or as part of the Information Technology Exchange Program or similar U.S. Government program? FORMCHECKBOX Yes and I do not have an NDA in this capacity FORMCHECKBOX Yes and I have an NDA in this capacity FORMCHECKBOX No 4. Have you ever been employed by the U.S. Government in either a civilian or military capacity, or served in the Reserve or Guard component of the U.S. Armed Services? FORMCHECKBOX Yes within the past five (5) years FORMCHECKBOX Yes more than five (5) years ago FORMCHECKBOX No If you answered 'No' to question 4 above, skip to the end and sign and date this form. If you answered 'Yes' to question 4 above, please continue.Military ServiceIf an offer of employment follows, please note you will be requested to provide a copy of your Member 4 DD214. Please do not send in your DD214 until requested. BRANCH OF MILITARY SERVICE FORMTEXT ?????CURRENT STATUS FORMCHECKBOX ACTIVE FORMCHECKBOX RETIRED FORMCHECKBOX TERMINAL LEAVE FORMCHECKBOX SEPARATED FORMCHECKBOX OTHERMILITARY RANK (Highest) FORMTEXT ?????MILITARY DATES OF SERVICE FRFOM (Mo/Day/Yr) FORMTEXT ?????MILITARY DATES OF SERVICE TO (Mo/Day/Yr) FORMTEXT ?????TERMINAL LEAVE DATE (if applicable) FORMTEXT ?????Government Experience GOVERNMENT AGENCY/BRANCH FORMTEXT ?????CURRENT STATUS FORMCHECKBOX ACTIVE FORMCHECKBOX RETIRED FORMCHECKBOX TRANSITION LEAVE FORMCHECKBOX SEPARATED FORMCHECKBOX OTHERLEVEL (Highest) (e.g., GS-15) FORMTEXT ?????GOVERNMENT DATES OF SERVICE FROM (Mo/Day/Yr) FORMTEXT ?????GOVERNMENT DATES OF SERVICE TO FORMTEXT ?????TRANSITION LEAVE DATE (if applicable) FORMTEXT ?????Government/Military Experience QuestionnaireForm C-411 (9-19)* Page 2 of 25. While employed by the U.S. Government (in either a civilian or military capacity), did you work personally and substantially on a particular matter that involved Northrop Grumman? FORMCHECKBOX Yes FORMCHECKBOX No6. Are you currently employed by the U.S. Government (civilian or military) (Note: employees on Terminal Leave are considered current government employees)? FORMCHECKBOX Yes FORMCHECKBOX NoIf you answered 'No' to question 6 above, skip to the end and sign and date this form. If you answered 'Yes' to question 6 above, please continue.7092958753475007. Are you permitted, under the Procurement Integrity Act (41 U.S.C. § 2101 et seq.), to engage in discussions with Northrop Grumman about possible future employment because: FORMCHECKBOX You are not (nor are you supervising anyone who is) participating personally or substantially in any federal agency procurement in which Northrop Grumman is a bidder or offeror. FORMCHECKBOX You participated personally & substantially (personal action or supervision) in a federal agency procurement where Northrop Grumman is a bidder or offeror & complied with all your written agency disqualification conditions & restrictions. Important Note: Provide a true and accurate copy of your valid disqualification, acknowledged by the U.S. Government supervisor, with this form.7092958753475008. Are you permitted, under the “Acts Affecting a Personal Financial Interest” statute (18 USC § 208), to seek employment with Northrop Grumman because: FORMCHECKBOX None of your government duties or responsibilities involve you (or anyone you supervise) personally and substantially taking any official action on any particular matter in which Northrop Grumman or any affiliate has a financial interest. FORMCHECKBOX Your government duties involved you, or someone you supervised, personally & substantially taking official action on official matters of Northrop Grumman but you complied with all your written agency disqualification conditions/restrictions. Important Note: Provide a true and accurate copy of your valid disqualification, acknowledged by the U.S. Government supervisor, with this form.CERTIFICATION/SIGNATUREI hereby certify that by entering my name, either by hand-written or by typing my name below, the foregoing information is true, accurate, and complete to the best of my knowledge and belief. I also intend for this document, if utilized in electronic form, to have the same force and effect as if personally signed by me in writing. SIGNATURE FORMTEXT ?????DATE FORMTEXT ?????Government/Military Experience QuestionnaireForm C-411 (9-19)* Instructions AttachmentConflict-of-Interest Regulations for Current AND FORMER Government (CIVILIAN and Military) EmployeesThank you for your interest in employment with Northrop Grumman (“the Company”). We are asking you specific questions regarding your government (civilian and military) role(s) and status, in order to ensure that it is appropriate to engage in employment discussions and consider you for the position(s) for which you have expressed interest. It is very important that you fully understand the questions and answer them accurately and completely. We encourage you to seek guidance from your agency/branch ethics office (e.g., designated agency ethics official), if you have any questions regarding how to answer the questions. Most significantly, if you are a current government employee (civilian or military), you must answer questions 7 and 8, and provide a copy of any applicable disqualification that evidences agency approval of your disqualification request.Definitions: The questions are written using specific terms, which are defined in the applicable government regulations and included, in part, below. If you have any questions regarding this terminology, please consult your designated agency ethics officer (DAEO). To participate "personally" means directly, and includes participation of a subordinate if actually directed by you in the matter.To participate "substantially" means that your involvement is either of significance to the matter or forms a basis for a reasonable appearance of such significance. It requires more than official responsibility, knowledge, perfunctory involvement, or involvement on an administrative or peripheral issue. A finding of substantiality may be based not only on the effort devoted to a matter, but on the importance of the effort. While a series of peripheral involvements may be insubstantial, the single act of approving may be substantial. In addition to approval, other acts may also be considered "substantial," such as participation in a critical step.The term "particular matter" includes any investigation, application, request for a ruling or determination, rulemaking, contract, controversy, claim, charge, accusation, arrest, or judicial or other proceeding. General rule-making is usually excluded from the term "particular matter," since general rule-making seldom involves specific parties. Consequently, it is possible that an employee who participated in a rule-making while employed by the Government will, after leaving Government service, be able to appear before his former agency concerning the application of the rule to his new private sector employer without violating the lifetime restrictions. The term does not encompass any matter before the Government; only those matters that arise to particular matters. The provision further requires that an employee's official participation in a particular matter must have taken place at a time when the matter involved a non-Federal party (or parties) and also involve such a party or parties at the time of the proposed representation, although these can be different parties. Finally, the restriction remains for the lifetime of the particular matter. For example, when a contract is re-competed and awarded, the new contract is generally considered a new particular matter."Official responsibility" is defined as the direct administrative or operating authority, whether intermediate or final, and either exercisable alone or with others, to approve, disapprove, or otherwise direct Government action. Accordingly, a matter is under your "official responsibility" if you had the power, either directly or through a subordinate, to approve, disapprove, or otherwise direct a Government action. Those areas assigned by statute, regulation, executive order, or job description usually determine the scope of an employee's official responsibility. All particular matters under consideration in an agency are under the official responsibility of the agency head, and each is under that of any intermediate supervisor having responsibility for the activities of a subordinate employee who actually participates in the matter. A matter was "actually pending" under a former employee's official responsibility if the matter was in fact referred to or under consideration by persons within the employee's area of responsibility. It is important to note that unlike section 207(a)(1), this restriction is triggered simply by virtue of the fact that the particular matter was pending under your official responsibility and does not require that you personally and substantially participated in the matter.SETA. “Systems engineering and technical assistance” means a combination of activities related to the development of technical information to support various acquisition processes. Examples of systems engineering and technical assistance activities include, but are not limited to, supporting acquisition efforts such as—?????(A)? Deriving requirements; ?????(B)? Performing technology assessments; ?????(C)? Developing acquisition strategies; ?????(D)? Conducting risk assessments; ?????(E)? Developing cost estimates; ?????(F)? Determining specifications;?????(G)? Evaluating contractor performance and conducting independent verification and validation;?????(H)? Directing other contractors’ (other than subcontractors) operations;?????(I)? Developing test requirements and evaluating test data;?????(J)? Developing work statements.A&AS. “Advisory and Assistance Services” is a legitimate way to improve Government services and operations. Accordingly, advisory and assistance services may be used at all organizational levels to help managers achieve maximum effectiveness or economy in their operations. Agencies may contract for advisory and assistance services, when essential to the agency’s mission, to --(1) Obtain outside points of view to avoid too limited judgment on critical issues;(2) Obtain advice regarding developments in industry, university, or foundation research;(3) Obtain the opinions, special knowledge, or skills of noted experts;(4) Enhance the understanding of, and develop alternative solutions to, complex issues;(5) Support and improve the operation of organizations; or(6) Ensure the more efficient or effective operation of managerial or hardware systems.“Special Government Employee” means an officer or employee of the executive or legislative branch of the United States Government, of any independent agency of the United States or of the District of Columbia, who is retained, designated, appointed, or employed to perform, with or without compensation, for not to exceed one hundred and thirty days during any period of three hundred and sixty-five consecutive days, temporary duties either on a full-time or intermittent basis, a part-time United States commissioner, a part-time United States magistrate judge, or, regardless of the number of days of appointment, an independent counsel appointed under chapter 40 of title 28 and any person appointed by that independent counsel under section 594(c) of title 28. Notwithstanding the next preceding sentence, every person serving as a part-time local representative of a Member of Congress in the Member’s home district or State shall be classified as a special Government employee. Notwithstanding sections 502, 2105(d), and 5534 of title 5, a Reserve officer of the Armed Forces, or an officer of the National Guard of the United States, unless otherwise an officer or employee of the United States, shall be classified as a special Government employee while on active duty solely for training. A Reserve officer of the Armed Forces or an officer of the National Guard of the United States who is voluntarily serving a period of extended active duty in excess of one hundred and thirty days shall be classified as an officer of the United States within the meaning of section 203 and sections 205 through 209 and 218. A Reserve officer of the Armed Forces or an officer of the National Guard of the United States who is serving involuntarily shall be classified as a special Government employee. The terms “officer or employee” and “special Government employee” as used in sections 203, 205, 207 through 209, and 218, shall not include enlisted members of the Armed Forces.“Information Technology Exchange Program” authorizes the temporary detail of information technology employees between the Federal Government and private sector organizations. The statute also gives Federal agencies the authority to accept private sector information technology employees detailed under the Information Technology Exchange Program. ................
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