Attachment 03 - EAL Application.pdf

DATE:

I request installation access for the following Non-DoD Visitor(s) in reference to the below function/event. I understand that the visitor(s) full name, date of birth and race will be used for background checks and that I will be responsible for the conduct of all visitors/guests for whom I will be sponsoring, for the duration of their visit at the 910 AW. *DO NOT ADD MINORS*

Sponsor Information:

Name/Rank Organization Duty Phone Cell Phone

Function/Event Information:

Type of Event Location Date Time

Non-DoD Visitors:

NAME (Last, Full First, M.I.) DOB YYYY/MM/DD DRIVER’S LICENSE#

STATE OF ISSUE

SEX

(M/F)

RACE CODE

*RACE CODES: American Indian or Alaskan Native-I; Asian or Pacific Islander-A; Origin of racial groups of Europe, North Africa or Middle East, Caucasian or Hispanic-W; Persons with origins in any of the black racial groups of Africa-B; No other race code available-U.

NOTE: IAW AFMAN 31-101_v3, para 2.14, the Installation Commander is only authorized to conduct an NCIC III name check on non-DoD affiliated civilians each visit. The required name check fields include a person’s name, sex, race and date of birth.

By signing, I acknowledge that all information is accurate to the best of my knowledge, and I understand that all non- DoD personnel will be required to be in possession of the identification documents listed in paragraph 3 in the instructions.

Sponsor Signature:

------------------------------------- For Police Services Use Only ---------------------------------------

Authenticated By:

Date/Time:

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