Atch 3 -Base Access Template.pdf
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- Attached to
- Well 1 Pump Repair
- Solicitation number
- FA480325B0013
About this file
The document is a base access request template for Shaw Air Force Base in South Carolina, designed to process criminal background history checks for base access. The form requires sponsors to provide detailed personal information for individuals seeking access, including full legal name, date of birth, social security number, state driver's license number, and U.S. citizenship status. The template emphasizes the sponsor's responsibility for ensuring that individuals turn in or retrieve their Defense Biometric Identification System (DBIDS) pass when access is no longer required, with potential consequences for misuse of approved privileges. The form is marked as Controlled Unclassified Information (CUI) and must be submitted by the sponsor from their government email to the 20 SFS/S-5V section.
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Text version
DEPARTMENT OF THE AIR FORCE
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
CUI
Victory By Valor
DATE:
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.
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.
This form must be sent by the sponsor from their government email and received at the email addresses/fax number listed above in the 20 SFS/S-5V section.
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)
File details come from the government source that posted it. Updated .