Atch 39 Nellis Single Pass 1 Year Request Template.docx

-- CONTROLLED UNCLASSIFIED INFORMATION--

DEPARTMENT OF THE AIR FORCE

99TH SECURITY FORCES SQUADRON (ACC)

NELLIS AIR FORCE BASE NEVADA

MEMORANDUM FOR 99 SFS/S5B

FROM (Sponsor): ________________________________Contact Number: ______________ (Rank, Full Name) (Including Area Code)

SUBJECT:

1. I request the below listed person be issued an installation pass:

AND State of Issue

NOTE: IDs must be REAL ID Compliant. If the ID is not compliant than an additional form of government issued ID is required (i.e. US Passport, original Birth Certificate with raised seal, etc.)

COUNTRY OF CITIZENSHIP: ________________________________________________________

(Second VALID form of Government ID required if not a US Citizen! i.e. Residency Card, Work Permit, etc.)

DAYS AUTHORIZED:

NOTE: 24/7 access will only be considered for employees who could be called in after normal business hours. (X or √ all that applies)

HOURS AUTHORIZED: ______________________________________________________________

(Example: Sun-Sat, 0700-1800 hours)

JUSTIFICATION: ___________________________________________________________________

REQUESTED EXPIRATION DATE: ____________________________________________________

(May NOT Exceed 1 year from today’s date)

DESTINATION: Nellis AFB If you need access to Creech AFB, you must coordinate your request with Creech Pass & ID

(702) 404-2318/0075)

2. The individual listed above has been briefed on installation entry procedures and conduct while on Nellis AFB. Upon termination of the contract or termination of employment, the installation pass will be returned to the Visitor Control Center or Pass and ID.

SPONSOR’S DOD ID#: ___________________________________

SPONSOR’S SIGNATURE: ________________________________DATE SIGNED: ____________

Fight’s On!

"The information herein is Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties."

Protect Defend Fight…HUA!

image1.jpeg