Atch 46-Nellis Single Pass (2 Months Max).pdf

DEPARTMENT OF THE AIR FORCE

99TH SECURITY FORCES SQUADRON (ACC)

NELLIS AIR FORCE BASE NEVADA

CUI

Controlled by: 99 SFS/S3B Category: PRVCY

Dissemination Control: FED ONLY

CUI

MEMORANDUM FOR 99 SFS/S3B

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

SUBJECT: Base Pass Request

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

Full Legal Name (Last, First, MI)

DL

State

Driver’s License Number Date of Birth

Full SSN

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

COUNTRY OF CITIZENSHIP: ________________________________________________________

Photo of Permanent Residency Card or Work Authorization Card required if not a US Citizen.

A Foreign Visitor Request (FVR) is required if they do not have the listed documents.

DAYS AUTHORIZED:

(X or highlight requested dates)

HOURS AUTHORIZED: ______________________________________________________________

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

JUSTIFICATION: ____________________________________________________________________

REQUESTED BEGIN & END DATE: _____________________________________________

(May NOT exceed 2 months from today’s date. Anything longer than 2 months will need an Exception to Policy completed.)

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

SPONSOR’S DOD/DBIDS ID#: ___________________________________

SPONSOR’S SIGNATURE: _______________________________ DATE SIGNED: ____________

Sun Mon Tues Wed Thurs Fri Sat