7. Contractor Travel Request Form.docx

ASCENSION TRAVEL REQUEST FORM

APACS COUNTRY/THEATER CLEARANCE REQUEST

(20230707)

1. REQUESTING ORGANIZATION:

A. ORGANIZATION CONTACT NAME:

B. ORGANIZATION LOCATION:

C. ORGANIZATION FAX NUMBER:

D. ORGANIZATION PHONE NUMBER:

E. ORGANIZATION EMAIL ADDRESS:

2. UNIT/FACILITY TO BE VISITED:

DETACHMENT 2, ASCENSION AUXILIARY AIRFIELD.

3. PROJECTED ON-SITE DATES:

A. DATE OF ASCENSION ISLAND ARRIVAL: 7 November 2023 B. DATE OF ASCENSION ISLAND DEPARTURE: 8 November 2023

4. PURPOSE OF VISIT (CONTRACT NUMBER): FA2521-23-B-0008 (YXTK 13-1806 RPR Feeder 5) Site Visit

5. PARTICULARS OF EACH VISITOR

A. FULL NAME (FIRST, MIDDLE, LAST (Jr, Sr)):

B. DATE OF BIRTH:

C. SSN:

D. GENDER:

E. NATIONALITY:

F. PASSPORT NUMBER: EXP DATE:

G. JOB TITLE/CLASSIFICATION:

H. PERSONAL EMAIL:

I. PERSONAL PHONE NUMBER:

J. TRAINING COMPLETION DATES:

I. MEMBER HAS CONFIRMED THEY ARE MEDICALLY PREPARED FOR THE TRAVEL DATES LISTED TO ASCENSION ISLAND IAW CORPORATE GUIDELINES (Y/N):

EACH TRAVEL REQUEST SHALL BE SUBMITTED A MINIMUM OF THIRTY (35) CALENDAR DAYS BEFORE THE REQUESTED TRAVEL DEPARTURE DATE. FAILURE TO DO SO MAY RESULT IN REQUEST DENIAL BY THE APPLICABLE CLEARANCE AUTHORITY. EACH TRAVELER SHALL HAVE COMPLETED ALL REQUIRED TRAINING AND CERTIFICATIONS AND IT IS THE CONTRACTOR'S RESPONSIBILITY TO KEEP CURRENT TRAINING RECORDS FOR EACH TRAVELER.

WHEN FORM IS COMPLETED, PRIVACY ACT OF 1974 AS AMENDED APPLIES--THIS DOCUMENT CONTAINS INFORMATION WHICH MUST BE PROTECTED IAW DOD 5400.11R, AFIS 33-119, 33-129, AND IS FOR OFFICIAL USE ONLY

CONTROLLED UNCLASSIFIED INFORMATION (CUI)

Training and Medical Information for Theater and Clearance.

(1) Level 1 Antiterrorism (AT) Awareness Training: Must be current and completed within 12 months (one (1) year) prior to entry into the AFRICOM AOR.

Level 1 AT Awareness Training is available on Joint Knowledge Online (JKO) https://jkodirect.jten.mil. Enroll in Course Number JS-US007.

Sponsor information to establish JKO Account. Name: Timothy R. Johnson. Official Email: timothy.johnson@spaceforce.mil. U.S. Phone: 321-494-5451

JKO Help Desk, Monday - Friday 0700-1900 EST. E-mail: jkohelpdesk@jten.mil. Phone. COMM: 757-203-5654 or DSN: 668-5654

(2) SERE 100.2 Level A Training Resources

SERE 100.2 Training is available on Joint Knowledge Online (JKO) https://jkodirect.jten.mil.

Go to: https://jkodirect.jten.mil/Atlas2/faces/page/coi/externalCourseAccess.seam?course_pr efix=J3T&course_number=A-US1329

Once you launch the course you will select the “Civilian” option. Contractors Authorized to Accompany the Force (CAAF) are required to complete SERE 100.2 available on Joint Knowledge Online (JKO). This course is tailored to CAAF personnel and meets Level A SERE training Theater Entry Requirements. To maintain currency CAAF personnel must re-accomplish this training requirement once every 36 months (3 years).

Sponsor information to establish JKO Account. Name: Timothy R. Johnson. Official Email: timothy.johnson@spaceforce.mil. U.S. Phone: 321-494-5451

JKO Help Desk, Monday - Friday 0700-1900 EST. E-mail: jkohelpdesk@jten.mil. Phone. COMM: 757-203-5654 or DSN: 668-5654

(3) Isolated Personnel Report (ISOPREP). Must be completed or reviewed within 12 months (one (1) year) of entering the AFRICOM AOR.

Personnel Recovery preparation is required to prepare for a situation when a traveler needs to be authenticated after they have become isolated, captured, missing, or detained; whether through accident (e.g., vehicle breaks down while traveling to a location), political turmoil (e.g., riot) or criminal/terrorist action (e.g., kidnapping). Travelers should be prepared to survive unassisted for no less than 96 hours.

Point of Contact (Primary) Emily Bachman at emily.bachman.1.ctr@spaceforce.mil, 321-494-6991, or (Alternate) Norris Gray at norris.gray.ctr@spaceforce.mil, 321-494-2867. Let them know you will be DoD Sponsored Contractor for a construction project at Ascension and need to complete the ISOPREP process

(4) Medical Assessment and Requirements:

Members will need to be medically prepared for the travel dates in accordance with their company’s corporate guidelines for overseas travel.