Attachment 4. JB CHS Form 111 Contractor Access Worksheet.pdf

CUI (when filled in)

Joint Base Charleston Form 111, Contractor Access Worksheet & Pass Procedures (20260115) Supersedes: All previous versions Prescribed by: JB CHS Instruction 31-106.

CUI

Contractor Access Worksheet & Pass Procedures

JOINT BASE CHARLESTON (JB CHS) CONTRACTOR ACCESS WORKSHEET

AUTHORTIY: Joint Base Charleston (JB CHS) Base Defense Plan 31-1. USC Section 3101 Title 44, USC 5, 552A and AFI 33-332 PURPOSE: The purpose of collecting personnel information is to support security personnel in establishing records that assess an individual's suitability for access to JB CHS to work under AF contracts. This information may be used to evaluate access eligibility and may also be utilized for other lawful purposes, including criminal background checks and legal proceedings.

INTENDED USE: All contractors and subcontractors requiring regular and frequent access to JB CHS in the performance of their official duties, refer to JB CHS Base Defense Plan 31-1 and JB CHS Instruction 31-106, Contractor Access Control Program, for further guidance.

DISCLOSURE: Disclosure of requested information is voluntary. However, failure to provide information may result in access privileges being refused or withdrawn. The Privacy Act Statement will apply throughout the duration of the contract.

SECTION A: APPLICANT INFORMATION

A-1: Name (Last, First, MI)

A-2: Driver’s License or ID Card Number

A-3: Driver’s License or ID Card State

A-4: Date of Birth A-5: US Citizen (Y/N. If N, list Citizenship Country)

A-6: SSN A-7. Phone

A-8a: Current Address:

Line 1 Street

A-8b: Current Address:

Line 2 Optional (e.g. Apt, Ste, Bldg)

A-8c: Current Address:

City, State

A-8d: Current Address:

ZIP Code

A-9: Signature (Wet or Digital)

A-10: Date

SECTION B: ACCESS INFORMATION

B-1: Company Name B-2: Company Phone

B-3: Days Access Needed (e.g. Monday-Friday)

B-4: Times (e.g. 0700 - 1700, 0000 - 2359)

B-5: Access Start Date B-6: Access End Date

B-7: Locations (e.g. AB Bldg 5, WS Bldg 2)

B-8: Badge or Temp

SECTION C: SPONSOR INFORMATION

C-1: Name (Last, First, MI)

C-2: Organization

C-3: Phone C-4: DoD ID

C-5: Signature (Wet or Digital)

C-6: Date

NOTE 1: Copy of Front and Back of driver’s License or Other Real ID Compliant Identification Must Be Attached.

NOTE 2: Contractor Pass Procedures are on the Reverse Side.

CUI (when filled in)

Joint Base Charleston Form 111, Contractor Access Worksheet & Pass Procedures (20260115) Supersedes: All previous versions Prescribed by: JB CHS Instruction 31-106.

CUI

Contractor Access Worksheet & Pass Procedures (Cont)

JOINT BASE CHARLESTON (JB CHS) CONTRACTOR ACCESS WORKSHEET

CONTRACTOR PASS PROCEDURES

1. All applications may be typed or hand-written. See below for field specific instructions:

-- A-9: Application must be wet or digitally signed by applicant.

-- B-5: Requested start date may be up to 30 calendar days before or 30 calendar days after date of turn in; however, start date of pass will be date pass is issued.

-- B-6: Requested end date cannot exceed the day prior to requested start date in the following year, including leap years (e.g. 29 Jun 25 -

28 Jun 26). Issued badge or pass end date may be before requested end date and is based on date of background check.

-- B-8: List "Badge" if access is required to the installation for 40 hours per work week for 180 calendar days or longer. List "Temp" if access is required for less than 40 hours per work week or for a duration of less than 180 calendar days. Temp passes will be issued in 29-day increments.

-- C-5: Application must be wet or digitally signed by an appointed base sponsor.

2. Application must include a copy of the front and back of the applicant's Real ID Driver’s License or other Real ID Compliant ID.

3. It is the responsibility of the company that is requesting the contractor badge/pass to verify the validity of the employee's driver’s license and legal status prior to the request being submitted. Any individual operating a vehicle on the installation must ensure that it meets the minimum insurance requirements, have a valid driver's license and vehicle registration in the vehicle.

4. Turn in the application to the VCC at which the pass will be picked up. Only appointed base sponsors are authorized to make pen and ink changes to an application at turn in. The following are the VCC addresses:

-- JB CHS-AB VCC, 700 W. Hill Blvd Bldg 1953, Joint Base Charleston, SC 29404 -- JB CHS-NWS VCC, 1650 Red Bank Rd Bldg 3, Goose Creek, SC 29445

5. An NCIC background check will be conducted based on information provided in the application. Erroneous information may result in delays or rejection. It is the applicant's responsibility to contact the applicable agency to correct the criteria resulting in denial.

6. Criminal history evaluation will be based on the following fitness determinations (see table below). A combination of convictions totaling to 50 or more points, or an offense identified as "DENIED" will result in access denial:

7. Sponsor will be notified the status of application via e-mail from Contract Security. The sponsor is responsible for notifying the prime contractor (contractor with which the government has a contract) of status.

8. Application processing may take up to 3 business days from drop-off of completed application.

9. Applicant must bring their driver’s license, registration and insurance for pickup of new pass. If the driver’s license does not comply with Real ID standards (i.e., no paper copy), a second form of identification compliant with Real ID standards must also be provided.

10. The issuance of a badge/pass is a privilege that can be withdrawn, and the individual can be barred from base for noncompliance with Joint Base Charleston policies and or USAF Directives. This badge/pass must be in possession of the contractor at all times while on the installation. Contractor badge/pass must be visible on the employee at all times.

11. If a contractor is terminated or upon completion of the job or the expiration of the identification card/pass, the Prime Contractor shall ensure that all base identification cards/passes issued to employees and subcontractor employees are returned to the issuing VCC.

12. If access is denied, the applicant may obtain additional information regarding denial reasons in-person at the VCC at which the application was processed. All applicants, excluding individuals who are registered sex offenders, currently on probation, or subject to an active warrant, have the right to appeal the outcome of their fitness determination. For additional details on the appeals process, please contact the VCC staff.