Attachment 4 - Locator Sheet.doc

LOCATOR

Revised 06/09 PLEASE PRINT (All civilian, military and contractor personnel need to complete ALL blocks if applicable.) Incomplete forms cannot be processed. See next page for Form Instructions

SSN# ________________ NAME:

(Last) (First) (Middle Initial) (Suffix)

*BRANCH: __________ RANK (MILITARY ONLY): __________ SERIES: __________ PAY PLAN (GS,GM,WG): __________ GRADE: __________

CITIZENSHIP: __________________ NICKNAME: ___________ COMPETENCY CODE: ________ POSITION TITLE: _________________

UIC#: _________ *SITE: ______ *BLDG#: _________ SUITE#: ________ ROOM#__________

PHYSICAL LOCATION: ________________________________________

TELEPHONE #: COMMERCIAL: (First#)___________________ (Second#) ___________________ FAX: ___________________

*see instructions on next page for detailed information

CONTRACTOR PERSONNEL ONLY:

NAME OF COMPANY: _____________________________________________________________

CONTRACT #: ___________________________________ EXPIRATION DATE: __________ EMP START DATE: __________

CONTRACT #: ___________________________________ EXPIRATION DATE: __________ EMP START DATE: __________

PAX CIVIL SERVICE or MILITARY POC: ______________________ PHONE #: ____________ SIGNATURE OF POC: ____________________

FORM INSTRUCTIONS

SSN

Provide Social Security Number.

NAME

Last Name/Last Name/Middle Initial/Suffix: Provide Last name, First Name, and Middle Initial. Suffix: JR, SR, III, etc.

BRANCH

Select from the following list of values: MIL NAVY SERVICE MEMBER, MILM MARINE SERVICE MEMBER, MILA AIR FORCE SERVICE MEMBER, MILY ARMY SERVICE MEMBER, MILC COAST GUARD SERVICE MEMBER, MILR MILITARY RESERVES, MILF FOREIGN MILITARY OFFICER, CIV CIVILIAN EMPLOYEE, CIVI CIVILIAN INTERN, CIVX CIVILIAN OTHER AGENCIES, CIVF CIVILIAN FOREIGN GOVERNMENT, CON CONTRACTOR EMPLOYEE ON-SITE, CONO CONTRACTOR EMPLOYEE OFF-SITE, CONF CONTRACTOR FOREIGN NATIONAL

RANK (Military Only)/SERIES/GRADE Provide the rank, series type, and alpha-numeric grade designator. Example: LT, 6412, O3

PAY PLAN/SERIES/GRADE (Civil Service)

Provide the series, pay plan, and grade. Example: GS-0343-09

CITIZENSHIP

Country of Citizenship: Provide the two-letter abbreviation. If Foreign National, please contact your on-site security team or Competency 7.4.1 at 301-342-9660.

NICKNAME

Provide a name you use other than your first, middle, or last name.

COMPETENCY CODE

Competency Code supported: Provide/List the competency code you support. Example: 4.5.1.0.0.0

POSITION TITLE

Example: Management Analyst

UIC

Provide the 5-digit numeric identification code of the Competency/Command you are supporting. Example: 00421.

SITE

Site Code: Select from the following sites where you will be performing work: A=NAWCAD/NAS Patuxent River, T= NAWCAD Webster Field, V=NAVAIR HQ Patuxent River/Webster Field, W=NAVAIR HQ Crystal City, B=NAWCAD Lakehurst, G=TSD Orlando, M=Pensacola, D=China Lake, E=Point Mugu, H=Jacksonville, J=Cherry Point, K=North Island, L=NAMRA Naples, S=NAPRA Japan, N = NATEC

BUILDING/SUITE/ROOM NUMBER

(ON-SITE) Building/Suite/Room Number: Provide a valid ON-SITE building, suite, and room number where you will be working.

(OFF-SITE) Enter “off-site” in the space provided. Provide the complete mailing address. Example: 12345 John Doe Lane, City, State and Zip Code

ZONE/UNIT NUMBER Provide the zone or unit mail stop number.

PHYSICAL LOCATION

City/State of exact location of employment.

TELEPHONE/FAX

Phone/Fax Number: Provide main phone and Fax number.

Contractor Data: TO BE COMPLETED BY PAX CIVIL SERVICE OR MILITARY POC Name of Company: Provide the official company name.

Contract Number(s): Provide the 13-character contract number(s) that the contractor will be working under. (Example: N0042196D0006)

Expiration Date: Provide the expiration date of the contract or delivery order. dd-mmm-yyyy

Employee Start Date: Provide the date the employee will begin work.

PAX Civil Service or Military POC/Phone Number/Signature: Provide name, phone number, and signature of PAX point of contact.

COMMENTS: Provide the reason for request. Example: WPS access

Privacy Act of 1974: This form contains identifiable personal data which is to be safeguarded pursuant to the Privacy Act of 1974. This information is to be released only to authorized personnel having a need to know for official uses. When not in use this form is to be stored in a locked cabinet or secured room.

Privacy Act of 1974: This form contains identifiable personal data which is to be safeguarded pursuant to the Privacy Act of 1974. This information is to be released only to authorized personnel having a need to know for official uses. When not in use this form is to be stored in a locked cabinet or secured room.