1. (2026) BLANK WITH EXAMPLE Shaw AFB Contractor Request Template (WORK PURPOSES).docx
DOCX document 184 KB Posted
- Attached to
- 1947 Remove and Replace Carpet - Shaw AFB
- Solicitation number
- FA480326Q0088
About this file
This is a contractor background check request template issued by the 20th Fighter Wing Security Forces Squadron (20 SFS/S-5V) at Shaw Air Force Base, South Carolina. The template is designed to process criminal background history checks and grant or deny base access for contractors and employees requiring entry to Shaw AFB. The form must be submitted by a government sponsor using their official government email to the 20 SFS/S-5V office, with confirmation provided once completed. Sponsors are responsible for ensuring that individuals listed turn in their Defense Biometric Identification System (DBIDS) pass upon termination or when access is no longer required, and for notifying Security Forces to deactivate passes if retrieval is not possible.
The template requires sponsor and individual information including full legal name, date of birth, Social Security number, state driver's license number with REAL ID compliance status, and U.S. citizenship verification. Specific instructions address non-U.S. citizens, requiring submission of scanned documentation such as foreign visas, permanent resident cards (Form I-551), or employment authorization cards (Form I-766) before visiting the Visitor Control Center (VCC). For the related Solicitation FA480326Q0088 regarding carpet replacement and transitions at Building 1947 on Shaw AFB, all base access requests must be received by Contract Specialist TSgt Allan Zajac at allan.zajac@us.af.mil no later than August 6, 2026 at 1400 EST, with a mandatory site visit scheduled for August 11, 2026 at 2:00 PM EST at the rear of Building 1947 near the loading dock.
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Text version
CUI
DEPARTMENT OF THE AIR FORCECUI
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
DATE: XX/XX/XXXX
MEMORANDUM FOR 20 SFS/S-5V:
This form MUST BE SENT BY THE SPONSOR listed from their government email and received at the email addresses/fax number listed above in the 20 SFS/S-5V section and will receive a confirmation email once completed with instructions.
FROM: (The person requesting background check be conducted and squadron/unit)
SUBJECT: (i.e Contractor/Employee needing access to Shaw AFB)
WHO: (Company or Organization the Contractor/Employee will be working for)
WHAT FOR: (i.e Construction, New Hire, Job Interview, Meeting, New CAC or CAC Renewal, Work order etc.)
WHERE: (Location Contractor/Employee will be working at or needing access to)
If base wide give justification: (i.e Individual needs access to multiple buildings on base)
WHEN: (The exact day/dates and hours the individual will need access to the base (i.e. May 10, 2022, 0800-1700hrs or from May 10, 2022- May 10, 2023 Monday-Saturday, 0700-1900hrs)
SPONSOR: (The CAC holding individual responsible for the individual listed below and their organization) DOD EDPI: The # on the back of you CAC
CONTACT INFO: (Sponsor’s GOV email and PHONE NUMBER W/EXTENSION)
The information below is protected under Privacy Act 1974 and will only be used to process Criminal Background History Checks to grant or deny access to Shaw AFB. It is further understood that anyone abusing approved privileges could, at a minimum, lose said privilege and possibly face criminal charges.
EXAMPLE
Full Legal Name (Last, First MI) Date Of Birth (Year/Mo/Day) Social Security Number
ST-DL #
(REAL ID Y/N)
U.S.
Citizen (Y/N)
| DOE, JOHN E. |
| 1995/01/01 |
| 123-45-6789 |
| SC-12345678 Y |
| Y |
********IF UNDER THE AGE OF 18, PLEASE COMPLETE A SEPARATE WORK REQUEST. *********
DO NOT FILL THIS PAGE PLEASE USE THE NEXT PAGE
DATE: 30-Jun-26
MEMORANDUM FOR 20 SFS/S-5V
FROM:
SUBJECT:
WHO:
WHAT FOR:
WHERE:
(If base wide give justification)
WHEN:
SPONSOR NAME:
DOD EDPI:
CONTACT INFO:
The information below is protected under Privacy Act 1974 and will only be used to process Criminal Background History Checks to grant or deny access to Shaw AFB. It is further understood that anyone abusing approved privileges could, at a minimum, lose said privilege and possibly face criminal charges.
Full Legal Name (Last, First MI) Date Of Birth (Year/Mo/Day) Social Security Number
ST-DL #
(REAL ID Y/N)
U.S.
Citizen (Y/N)
PLEASE READ THE STATEMENTS BELOW
1. I UNDERSTAND THAT AS THE SPONSOR I AM RESPONSIBLE FOR THE PERSON(S) LISTED ON THIS FORM, AND FOR ENSURING THE ABOVE NAME INDIVIDUAL(S) TURNS IN THE DBIDS PASS OR RETRIEVE THE PASS ONCE THE INDIVIDUAL(S) ARE TERMINATED, QUIT, OR NO LONGER REQUIRES ACCESS. IF I AM NOT ABLE TO RETRIEVE THE PASS, I WILL NOTIFY SECURITY FORCES TO HAVE THE INDIVIDUAL(S) PASS DEACTIVATED IN DBIDS.
2. If you, as the sponsor, filled out the request and answered N for U.S Citizen please make sure you submit scanned in documents before coming to the VCC. **i.e.-FOREIGN VISA, PERMANENT RESIDENT CARD (Form I-551) & EMPLOYMENT AUTHORIZATION CARD (Form I-766) HOLDERS, ETC.
3. AS THE SPONSOR, I will inform my visitors they must have identification in compliance with the Real ID Act OR have a Federal ID in which cases they do not. If they do not, they will not be able to receive a pass from the VCC.
CUICUI
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File details come from the government source that posted it. Updated .