Daniel Orr
Overview
25
25
years of professional experience
Work History
Production Foreman
Knox Creek Coal Corporation
01.2005 - 01.2015
- Street: 2295 US-460
- City: Raven
- State: VA
- Country: Field is blank! Zip Code: 24639
- Employer's Telephone Number
- International or DSN: {Box NOT Checked!}
- Number: 2765962000
- Extension: Field is blank!
- Job Location Street Address (if different than employer address)
- Street: Field is blank!
- City: Field is blank! State: Field is blank! Country: Field is blank! Zip Code: Field is blank!
- Electronic Questionnaires for Investigations Processing (e-QIP)
- Investigation Request #18652604 for Applicant SSN 248-81-2857
- Page 8 of 10
- Archival Copy
- Certified at, 17 17:11:32
- Data Hash Code:af85a078f4e24ffd7cbab365760941be1992b2529ca3259a4f73840
- PRIVACY ACT INFORMATION
- Job Location Telephone Number
- International or DSN: {Box NOT Checked!}
- Number: Field is blank! Extension: Field is blank!
- Supervisor Information Same as Employer: {Box NOT Checked!}
- Supervisor's Name: Mark Jackson
- Supervisor's Street Address (if different than job location)
- Street: 2295 US-460
- City: Raven
- State: VA
- Country: Field is blank! Zip Code: 24639
- Supervisor's Telephone Number
- International or DSN: {Box NOT Checked!}
- Number: 2765962017
- Extension: Field is blank!
- Provide Previous Periods of Activity if you worked for this employer on more than one occasion at the same location
- After entering the most recent period of employment above, provide previous periods of employment at the same location on the additional lines provided
- For example, if you worked at, 17 17:11:32
- Data Hash Code:af85a078f4e24ffd7cbab365760941be1992b2529ca3259a4f73840
Wayne Davis
01.1990 - 01.2001
- (Estimated)
- To (Month/Year): Present
- Name
- Home or Work Address
- Street: PO Drawer 159
- City: Lebanon
- State: VA
- Country: Field is blank! Zip Code: 24266
- Telephone Number
- Electronic Questionnaires for Investigations Processing (e-QIP)
- Investigation Request #18652604 for Applicant SSN 248-81-2857
- Page 9 of 10
- Archival Copy
- Certified at
Mercer County Career
08.2005
- City: Princeton
- State: WV
- Country: Field is blank! Zip Code: 24740
- Provide a detailed entry for each degree, diploma, etc
- You received from this school
- Degree/Diploma/Other (No Entry Provided)
- Additional Comments
- Received Journeyman's licenses for West Virginia in 2006
- Also Received welding certifications
- (End of List)
- Section 10: Your Employment Activities
- Provide a detailed entry for each of your employment activities for the last 5 years
- You should list all full-time work, part-time work, military service, temporary military duty locations over 90 days, self-employment, other paid work, and all periods of unemployment
- The entire 5-year period must be accounted for without breaks, but you need not list employments before your 16th birthday
- Dates of Activity
- From (Month, Present
- Use one of the codes listed below to identify the type of employment:
- Type of Employment
- Active military duty stations: {Box NOT Checked!}
- National Guard/Reserve: {Box NOT Checked!}
- U.S.P.H.S
- Commissioned Corps: {Box NOT Checked!}
- Other Federal employment: {Box NOT Checked!}
- State Government (Non-Federal employment): {Box NOT Checked!}
- Self-employment: {Box NOT Checked!}
- Unemployment: {Box NOT Checked!}
- Federal Contractor: {Box NOT Checked!}
- Other: { xBox IS Checked!} .
Marty Deel
08.2005
- Month/Year): Present
- Home or Work Address
- Street: 13351 Riverside Drive
- City: Oakwood
- State: VA
- Country: Field is blank! Zip Code: 24631
- Telephone Number
- International or DSN: {Box NOT Checked!}
- Number: 2764981758
- Extension: Field is blank! Time: Day
- 3
Paul Sutherland
08.2005
- Home or Work Address
- Street: 13351 Riverside Drive
- City: Oakwood
- State: VA
- Country: Field is blank! Zip Code: 24631
- Telephone Number
- International or DSN: {Box NOT Checked!}
- Number: 2764981758
- Extension: Field is blank! Time: Field is blank!
Education
Page 7 of 10 Archival Copy Certified at 2015-05 - undefined
Where You Went To School, Junior High School
17 17
11:32 - undefined
Accomplishments
- Penalties for Inaccurate or False Statements
- The United States Criminal Code (title 18, section 1001) provides that knowingly falsifying or concealing a material fact is a felony which may result in fines of up to $10,000, and/or 5 years imprisonment, or both
- In addition, Federal agencies generally fire, or disqualify individuals who have materially and deliberately falsified these forms, and this remains a part of the permanent record for future placements
- Your trustworthiness is a very important consideration in deciding your suitability
- Your prospects of placement are better if you answer all questions truthfully and completely
- You will have adequate opportunity to explain any information you give us on the form and to make your comments part of the record
- Disclosure of Information
- The information you give us is for the purpose of determining your suitability for Federal employment; we will protect it from unauthorized disclosure
- The collection, maintenance, and disclosure of background investigative information is governed by the Privacy Act
- The agency which requested the investigation and the agency which conducted the investigation have published notices in the Federal Register describing the systems of records in which your records will be maintained
- You may obtain copies of the relevant notices from the person who gave you this form
- The information on this form, and information we collect during an investigation may be disclosed without your consent as permitted by the Privacy Act (5, 5
- To a Federal, State, local, foreign, tribal, or other public authority the fact that this system of records contains information relevant to the retention of an employee, or the retention of a security clearance, contract, license, grant, or other benefit
- The other agency or licensing organization may then make a request supported by written consent of the individual for the entire record if it so chooses
- No disclosure will be made unless the information has been determined to be sufficiently reliable to support a referral to another office within the agency or to another Federal agency for criminal, civil, administrative, personnel, or regulatory action
- To contractors, grantees, experts, consultants, or volunteers when necessary to perform a function or service related to this record for which they have been engaged
- Such recipients shall be required to comply with the
- Privacy Act of 1974, as amended
- To the news media or the general public, factual information the disclosure of which would be in the public interest and which would not constitute an unwarranted invasion of personal privacy
- To a Federal, State, or local agency, or other appropriate entities or individuals, or through established liaison channels to selected foreign governments, in order to enable an intelligence agency to carry out its responsibilities under the National Security Act of 1947 as amended, the CIA Act of 1949 as amended
- Executive Order 12333 or any successor order, applicable national security directives, or classified implementing procedures approved by the Attorney General and promulgated pursuant to such statutes, orders or directives
- To a Member of Congress or to a Congressional staff member in response to an inquiry of the Congressional office made at the written request of the constituent about whom the record is maintained
- To the National Archives and Records Administration for records management inspections conducted underUSC 2904 and 2906
- To the Office of Management and Budget when necessary to the review of private relief legislation
- PUBLIC BURDEN INFORMATION
- Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information
- Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to
- Reports and Forms Management Officer, United States Office of Personnel Management, 1900 E Street, N.W.
- Room CHP-500, Washington, D.C
- 20415
- Do not send your completed form to this address
- The OMB No.0005 is currently valid
- OPM may not collect this information and you are not required to respond unless this number is displayed
- Sections 1-6: Your Identifying Information
- Provide the following information about your identity
- International or DSN: {Box NOT Checked!}
- Number: 2762660272
- Extension: Field is blank! Time: Day
- (End of List)
- Section 12: Your Selective Service Record
- Validation Responses
- Message: Provide a response for Registration Number
- Response:
- I do not know the requested information.: { xBox IS Checked!}
- A
- Are you a male born after December 31, 1959?
- Yes: { xBox IS Checked!}
- No: {Box NOT Checked!}
- B
- Have you registered with the Selective Service System?
- Yes: { xBox IS Checked!}
- No: {Box NOT Checked!} .
Interests
Month/Day/Year: ~ / ~ / ~
State Department Form 240 - Report of Birth Abroad of a Citizen of the United States
Give the date the form was prepared and give an explanation if needed
Date Form Prepared
Month/Day/Year: ~ / ~ / ~
Explanation
Field is blank!
US Passport
This may be either a current or previous US Passport
Passport Number: 463922532
Date Issued
Month/Day/Year: 05/08/2010
Electronic Questionnaires for Investigations Processing (e-QIP)
Investigation Request #18652604 for Applicant SSN 248-81-2857
Page 6 of 10
Archival Copy
Certified at 2015-05-17 17:11:32
Data Hash Code:
22598134eaf85a078f4e24ffd7cbab365760941be1992b2529ca3259a4f73840
PRIVACY ACT INFORMATION
Item d, Dual Citizenship
If you are (or were) a dual citizen of the United States and another country, provide the name of that country
Country(ies) of Dual Citizenship ( Not Applicable: { xBox IS Checked!} )
(No Entry Provided)
Item e, Alien,
Additional Comments
, Field is blank!
Certification That My Answers Are True
My statements on this form, and any attachments to it, are true, complete, and correct to the best of my
knowledge and belief and are made in good faith I understand that a knowing and willful false statement on this
form can be punished by fine or imprisonment or both (See section 1001 of title 18, United States Code)
Signature (Sign in ink)
(Signature on filesee Investigation Request #18652604 Signature Forms)
Date
Timeline
Mercer County Career
08.2005
Marty Deel
08.2005
Paul Sutherland
08.2005
Production Foreman
Knox Creek Coal Corporation
01.2005 - 01.2015
Wayne Davis
01.1990 - 01.2001
Page 7 of 10 Archival Copy Certified at 2015-05 - undefined
Where You Went To School, Junior High School
11:32 - undefined
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