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Self Certification of Continuous Service REV

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A PDF document (201 KB) attached to PN: 438-21-403, Renovate First Floor Kitchen (SF), from the Department of Veterans Affairs. Due Nov 4, 2026, 1:00 PM (UTC-6).

File name: Self Certification of Continuous Service REV 02-12-2025.pdf

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DEPARTMENT OF VETERANS AFFAIRS

OPERATIONS, SECURITY, AND PREPAREDNESS

PERSONNEL VETTING AND CREDENTIAL MANAGEMENT

PERSONNEL SECURITY ADJUDICATION CENTER

Self Certification of Continuous Service
I hereby certify my break in service from my last federal employment is indicated by the block checked below.
Federal employment is defined as any branch of the United States military (Active, Guard or Reserve), federal government civilian employee (any federal government agency), or a contractor working for the federal government. (Select One)

I have NOT had a break in service.
My break in service is less than 24 months.
My break in service is greater than 36 months, but less than 60 My break in service is greater than 60 months; or I have never had federal employment as defined above.

Full Name:

Social Security Number:

Signature:

Date:

Self Certification of Continuous Service Form
Revised June 27, 2025
Previous Versions are Obsolete

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