ML20148B906
| ML20148B906 | |
| Person / Time | |
|---|---|
| Issue date: | 03/03/1997 |
| From: | J. J. Barton Advisory Committee on Reactor Safeguards |
| To: | Duraiswamy S Advisory Committee on Reactor Safeguards |
| Shared Package | |
| ML20148B866 | List: |
| References | |
| ACRS-3052, NUDOCS 9705130405 | |
| Download: ML20148B906 (5) | |
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Rowe Lists Disc: Screen 2:2/25/97 l
GENERAL SCREENING INFORMATION FOR ACRS/ACNW CANDIDATES !
The ACRS and ACNW are long-standing advisory committees whose members must represent the highest standards of professional and ethical conduct. To maintain these standards, each candidate for membership is carefully screened, and, as a condition of employment, is required to have a security clearance and is required to meet agency requirements related to possible
, conflicts of interests; Your answers to the following questions would assist us in making a recommendation to the Commission with respect to your candidacy:
, 1. If you, your spouse, or minor children own stocks or any other securities of companies in the nuclear or related industries (list attached) or have financial conflicts of interests which could adversely affect you to serve as an ACRS or ACNW member, you could be required to dispose of such financial assets prior to becoming an ACRS/ACNW member.
Please review the attached list and indicate if you would be unwilling to dispose of such assets, should you be required to do so.
No Yes If yes, please explain.'
- 2. Do you or your spouse have any significant financial interest with the Federal Government through contracts, consulting services, or grants?
No Yes If yes, please explain.
- 3. In addition to your present employment, are you currently affiliated as an officer, director, trustee, partner, proprietor, employee, contractor, or consultant with a corporation, other business entities, nonprofit organizations, or educational institutions, foreign or domestic?
No Yes If yes, please list such entities and your relationship.
Space for explanation is provided at the end of this document.
- 4.
Do you have an agreement or arrangement for future .
employment, leave of absence, or continuation of payments by a former employer (including severance payments or >
continuing participation in an employee benefit plan, such as a pension or annuity plan)?
No Yes If yes, please list.
- 5. Have you or your spouse been registered as an agent for a foreign principal or been exempted from such registration?
No Yes If yes, please explain.
- 6. Do you hold a membership or position with any professional
, organization or any other organization that might present a potential conflict of interest? ,
No Yes If yes, please explain.
- 7. Do you know of any other information that could suggest a :
conflict of interest?
No Yes If yes, please explain.
- 8. Have you ever been granted a Government security clearance?
No Yes If yes, please explain when it was issued and for what purpose.
- 9. Have you ever been denied a Government security clearance?
No Yes If yes, please explain.
- 10. Have you ever had a professional license withdrawn, suspended, or revoked?
No Yes If yes, please explain.
- 11. Other than for a security clearance, have you ever to your knowledge been the subject of an investigation by the Federal Government or by a state or local government? (Tax audits by Federal or State or local authorities where there was no finding of a violation of law are excluded.)
No Yes If yes, please explain.
- 12. Have you sver been arrested, charged, or convicted of a felony or misdemeanor offense?
No Yes If yes, please explain.
- 13. In the past 15 years, have you been reassigned to another job, or forced to leave from, or voluntarily severed your employment as a result of allegations of misconduct,
l 3 i
. j unsatisfactory performance or other unfavorable circumstances? l No -Yes If yes, please explain. l
- 14. Have you or any company you were employed by ever received a r severity Level III or more serious violation from the NRC as l a result of particular matters under your control? If so, i' did the violation involve submitting inaccurate or incomplete information to the NRC or retaliation against' employees for raising safety concerns?
No Yes If yes, please explain. .
Please use the space below for any questions on the previous pages for.which you responded "yes," or for any other clarifying I
-information. '
i i
l Please certify by your signature that, to the best of your knowledge and belief, all of your answers are correct and complete. The issues addressed in the above questions are i relevant to the conflict-of-interest review and security clearance investigation that are. conditions of employment for ;
ACRS and ACNW members. The information you have provided is protected under the Privacy Act, 5 U.S.C. 552a., and will be released only to authorized individuals who have a need to review this information.
Name I
Date !
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