2. Base Access WORKSHEET V9_Dec20_ACC (002).pdf

Joint Base Charleston (JB CHS) Worksheet for Base Access Applicant Complete Name

(Last, First, Middle) Applicant Complete Address

(Street, Apt Number, City, State, Zip) SSAN App DOB

(MM/DD/YY) Place of Birth App Driver’s License or ID Card # and State of issue

Printed Name/UNIT:

CAC DoD Control Number for DBIDS:

JB CHS Contract Security Worksheet for Base Access (Rev #9/01 December 2020) This worksheet is For Official Use Only (FOUO) and must be protected under the Privacy Act of 1974, as amended.

Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties.

Controlled Unclassified Information (CUI)

#1 COMPANY NAME:

#2 COMPANY PHONE #:

#3 DAYS/TIMES ACCESS NEEDED:

#4 DESCRIPTION OF WORK TO BE PERFORMED:

#5 LOCATION OF WORK TO BE PERFORMED:

#6 START DATE: #7 END DATE:

#9 Attach legible copy of State Drivers License or State ID card with clear photo

#11 PRIME Contractor Email:

#12 Applicant Signature:

#13 Date:

#14 SPONSOR INFORMATION

Signature/Date:

Phone Number:

NOTE: INSTRUCTIONS FOR COMPLETING THIS WORKSHEET ARE ON THE REVERSE SIDE.

____BADGE ____ TEMP

#8 US CITIZEN:

#10 Have you ever been charged or convicted with a Felony? Yes No

Applicant

Yes No

Contract Security (VCC ONLY): _______

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

1106096534A Highlight

Joint Base Charleston (JB CHS) Worksheet for base access Instructions

#1 thru #8: Self Explanatory #9: Must attach a copy of Drivers License or State ID with a clear Photo. Failure to provide this and your application will not be processed.

#10 When answering the FELONY question be honest! If the NCIC investigation produces a positive finding and you answered “NO”, your access to JB CHS will be denied. Any individual convicted of a felony to include but not limited to: murder, assault w/intent to commit murder, rape, extortion, robbery, armed robbery, any drug offense and other Felony offenses will be denied access to JB CHS. In addition, any individual currently on parole, probation, have an active warrant or on the Sex Offender Registry will be automatically denied access to the installation.

(Employee MUST initial/No One Else).

#11 thru #14: Self Explanatory

HOW LONG DOES IT TAKE

You do not get the worksheet back once it has been turned into the SFS VCC. The worksheet may take up to 72-hours to process and sometimes longer if discrepancies are found.

CONTRACTOR PASS PROCEDURES

(a) Once the contracting company hires the individual, they will be required to fill out all information on the front of this worksheet, so they can obtain a badge/pass. It is the responsibility of the company requesting the contractor badge/pass to verify the validity of the employee’s driver license and legal status prior to the request being submitted. Any individual operating a vehicle on the installation must insure that it meets the minimum insurance requirements, have a valid Driver’s License and Vehicle Registration in the vehicle. The issuance of a badge/pass is a privilege that can be withdrawn, and the individual can be barred from base for noncompliance with Joint Base Charleston policies and or USAF Directives. This badge/pass must be in the possession of the contractor at all times while on the installation. Contractor badge/pass must be visible on the employee at all times.

(b) When reporting to the Visitor Control Center to obtain an identification badge/pass, each employee will present a valid driver’s license or state issued picture identification. Drivers License that say "Not For Federal Use", Nor For Federal Purpose" or "Not For Federal Identification" will NOT be accepted.

(c) The badge/pass does not allow family members or friends to be sponsored on the installation at any time. In cases when family or friends must drive the contractor to the base, the drop off point is at the base entry gates. Employees are responsible for their own transportation to the job site.

(d) If a contractor is terminated or upon completion of the job or the expiration of the identification card/pass, the prime contractor shall ensure that all base identification cards/passes issued to employees and subcontractor employees are returned to the issuing office. Either Security Forces Visitor Control Center on Air Base, Bldg. #1953, or Security Forces Visitor Control Center on Weapon Station, Bldg. #3 sfsvcc

1106096534A Highlight