Warning and Assuarance to Contract Employee Required to Provide Information

• Legal Form Number: BP-A0773
• Date: 2010-06
• Year: 2010
• Section: Federal Bureau of Prisons

WARNING AND ASSURANCE TO CONTRACT EMPLOYEE

REQUIRED TO PROVIDE INFORMATION U.S. DEPARTMENT OF JUSTICE

FEDERAL BUREAU OF PRISONS

BP-A0773

JUN 10

This is an official administrative inquiry regarding misconduct or improper per formance of official duties:

DateContract Employee signature

This inquiry pertains to:

The purpose of this interview is to obtain information which will assist in the determination of whether administrative action

is warranted.

You are going to be asked a number of questions regarding the performance of yo ur official duties.

You have a duty to reply to these questions and agency administrative action, t o include preclusion from working with

federal offenders, may be undertaken if you refuse or fail to reply fully and t ruthfully.

Neither your answer nor any information or evidence gained by reason of your an swers can be used against you in any

criminal proceeding, except that if you knowingly and willfully provide false s tatements or information in your answers, you

may be criminally prosecuted for that action. The answers you furnish and any formation or evidence resulting there from

may be used to determine your suitability for working with federal offenders.

ACKNOWLEDGMENT

I have read and understand my rights and obligations set forth above:

DateSignature of Bureau of Prisons Official Conducting Inquiry

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