Attachment 5 - Robins AFB Access Requirements (Site Visit)..pdf

Guest Requirements 3 Days or less

Individuals requesting passes for three days or less are required to have:

Valid Driver’s License Valid Vehicle Registration (Hard Copy – on hand) Valid Insurance (may be hard copy or digitally accessible)

SECURE PROTECT SERVE

Greater than 3 Days

Individuals requesting passes for more than three days (Badges):

Valid Driver’s License Social Security Card Valid Vehicle Registration (Hard Copy – on hand) Valid Insurance (may be hard copy or digitally accessible)

Note: No background checks will be conducted prior to the Visitor arrival at Building 219

RFQ SP3300-21-Q-0065

Attachment 5: Robins AFB Access Requirements (Site Visit)

Purpose of Affidavits The Affidavit is used for requesting personal information to assist security personnel in developing records to document non-DOD card holder suitability for requesting access to Robins Air Force Base, Georgia Affidavits are used so that Badging Agents may sponsor more than five individuals at a time on behalf of the hosting unit

Always use a new affidavit form for each person. DO NOT whiteout affidavits or reuse someone else’s in any way

SECURE PROTECT SERVE

Filling Out Affidavits The applicant will fill out their legal information into the form Do not have the applicant fill out Block 3

SECURE PROTECT SERVE

The applicant will place their initials each “Yes or No” category that applies to the Visitor Yes answers will need to be explained in the portion provided

SECURE PROTECT SERVE

Applicants will sign the Background Check waiver it in the Visitor Center when they come in for their pass/badge Building number or location of employment is where specifically the contractor/civilian will need access to travel to (example: Bld 300, housing, basewide, etc) Cannot have access for more than 1 year

SECURE PROTECT SERVE

Take Away Affidavits need legal names not nicknames Do not place SSAN’s on affidavits Affidavits will be held at the Visitor Center for a 5 days only Affidavits will be send to me at least 48 hours before a visit

SECURE PROTECT SERVE

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SFS. O

riginal to Em ployee. This data w ill be used to screen individuals w ho have or are seeking access to U S A ir Force installations or facilities controlled by the A ir Force. Please answ er each question. A ccess w ill be denied if this questionnaire is incom plete or m issing from the C ontractor A ccess Packet. This inform ation w ill be used to generate state and federal crim inal history checks C

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O H ave you ever been barred from entry/access to any m ilitary installation or facility?

H ave you been issued a sum m ons, citation or ticket to appear in court in a crim inal proceeding against you; are you on trial or aw aiting a trial on crim inal charges; or are you currently aw aiting sentencing for a crim inal offense?

H ave you ever received deferred adjudication from any court?

H ave you ever been charged w ith any felony offense?

H ave you ever been convicted of any felony offense?

H ave you ever been arrested by any police officer, sheriff, m arshal or any other type of law enforcem ent officer?

H ave you ever been jailed or im prisoned for any length of tim e? (M inutes, H ours, D ays, M onths, Y ears)

H ave you ever been charged w ith a firearm sor explosives offense?

H ave you ever been charged of espionage, sabotage, treason, m urder, sexual assault, arm ed assault or robbery, rape, child m olestation, felony drug possession w ith intent to sell or drug distribution?

D o you have any open w arrants? (reason, county)

If you answ ered “Y es” to any question above, explain in detail below . Y ou m ay attach a separate page if necessary. Y ou are required to answ er each question(s) fully and truthfully. Y our failure to com ply could be grounds for base access denial.

The inform ation herein is For O fficial U se O nly (FO U

O ) w hich m ust be protected under the Freedom of Inform ation A ct of 1966 and Privacy A ct of 1974, as am ended. U nauthorized disclosure or m isuse of this PER

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N m ay result in crim inal and/or civil penalties.

B ackground Check R elease Form as of 21 N ovem ber 2014

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N I attest that I have been briefed by m y em ployer/sponsor, and understand the purpose of the background check. I understand the inform ation on this form is being collected in accordance w ith 50 U

.S.C ., Section 797 and D oD D

5200.8 perm itting the installation com m ander to lim it access to the installation for security reasons and that the inform ation provided w ill be used to screen personnel w ho are seeking access to U

.S. A ir Force installations. I have voluntarily com pleted this form and shall provide the U .S. A ir Force a copy of m y fingerprints w hen requested. I understand that by signing the application I acknow ledge that I have been m ade aw are of, and have review ed the list of R obinsA

FB

“D isqualifying Factors” above. I hereby give consent and authorization for the A ir Force to conduct any additional background screenings deem ed necessary over the next 12 m onths, unless otherw ise directed by 78

SFS, to include com paring/checking m y fingerprints against local, state and federal crim inal databases. The inform ation I have provided on thisapplication is true, com plete and correct to the best of m y know ledge and is provided in good faith. I understand that know ingly and w illfully m aking false statem ents can be punished by fine, im prisonm ent,or both (18 U .S.C

Section 1001).

A pplicantSignature________________________________________D ate:_____________________ C om pany N am e:______________________________________________________________________

Sponsor/B adging A gent: ____________________________________ Title: _____________________ N am e of Squadron: ___________________________________ Phone N um ber : __________________

B uilding # or location of em ploym ent _____________________________________________________

Expiration D ate of B adge/Pass and A ccess Tim e Fram e: _______________________________________

Privacy A ct Statem ent A

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Y : Section 3101 Title 44, U nited States C ode,5 U

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552A

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FI 33-332

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(S): The purpose forrequesting personal inform ation is to assist police personnel in docum enting contractor em ployee suitability for access to U

SA

F installations. The Social Security num ber (SSA N and D ate of B irth (D

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) are necessary to identify the person and records. This inform ation m ay be used to determ ine suitability of person desiring access to the installation as w ell as for law ful purposes including law enforcem ent and litigation.

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: For all contractors and subcontractors w ho require regular and frequent access to the installation in perform ance of their official duties.

To allow base access to governm ent and federal agency em ployees and their fam ily m em bers. Patrons described in

A FI 34-101, Table A

2.2.are authorized lim ited use of m ilitary Services M W

R activities at the discretion of the installation com m ander provided adequate facilities are available and activities are currently underutilized by higher priority users. R obinsServices M W

R activities are underutilized.

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E : D isclosure of requested inform ation is m andatory. Failure to provide inform ation w ill result in access privileges being refused or w ithdraw

n. The Privacy A ct Statem ent w ill apply throughout the duration of the

A ir Force contract w hile serving in the capacity of prim e contractor or subcontractor/supplier em ployee.

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E The public reporting burden for this collection of inform ation is estim ated to take 3 to 30 days per response, including the tim efram e for review ing instructions, searching existing data sources, gathering and m aintaining data needed, and com pleting and review ing the collection of inform ation.

Sponsor/B adging A gent D igital Signature:

78 SFS

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The inform ation herein is For O fficial U se O nly (FO U

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N m ay result in crim inal and/or civil penalties.

B ackground Check R elease Form as of 21 N ovem ber 2014

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468-5831