Attachment 4-Base Pass Request.pdf

DATE: 23 June 2020

TO: 20 SFS / S-2, Investigations, 895-3600

FROM: 20/CONS

SUBJECT: Contractor(s) needing access to Shaw

COMPANY NAME:

WHAT FOR: Site Visit for Solicitation Issued for Bldg. 1411 Vindicator IDS Installation

WHERE: Bldg. 1411

WHEN: 9 July 2020 @ 2:00 PM EST

SPONSOR INFO: Carrie Mindieta (803) 895-9864 Jackson Woods (803) 895-9434

DAY PAPER PASS (good for one year): No

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 lose privileges and face criminal charges.

NAME SSN DOB ST-DL NO. US CITIZEN

I UNDERSTAND THAT AS SPONSOR, I AM RESPONSIBLE FOR THE PERSON(S) LISTED ON

THIS FORM AND FOR ENSURING THE ABOVE NAME INDIVIDUAL(S) TURN(S) IN PASS OR

RETRIEVE IT ONCE THE INDIVIDUAL(S) ARE TERMINATED, QUIT, OR NO LONGER

REQUIRES ACCESS. IF I AM NOT ABLE TO RETRIEVE IT, I WILL NOTIFY SECURITY

FORCES ISSUING AUTHORITY TO HAVE THE INDIVIDUAL(S) PASS DEACTIVATED.

This form must be Authenticated and received through 20sfs.backgroundchec@shaw.af.mil from the actual sponsor’s email account, with the understanding that by submitting this form sponsor agrees to all conditions implied on this form.

mailto:20sfs.backgroundchec@shaw.af.mil