Attachment C- Access Procedures - POM NonCitizen 23 May 2023.pdf

APPLICATION FOR INSTALLATION ACCESS

(FOR NON U.S. CITIZEN APPLICANTS ONLY)

1. LAST NAME, FIRST NAME, MIDDLE INITIAL

POM Form 7-1, October 2015 PREVIOUS EDITION IS OBSOLETE Page 1 of 2

TO

SIGNATURE DATE

TO

MONDAY SATURDAY SUNDAY FRIDAY THURSDAY WEDNESDAYTUESDAY

FROM FROM

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS DATE OF REQUESTED ACCESS (MM/DD/YYYY)

ISSUING STATE DRIVER'S LICENSE NUMBER

CITIZENSHIP COUNTRY OF BIRTH

PASSPORT NUMBER PLACE OF ISSUE

ALIEN REGISTRATION NUMBER PLACE OF ISSUE

VISA NUMBER PLACE OF ISSUE

DATE OF BIRTH (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

2. LAST NAME, FIRST NAME, MIDDLE INITIAL

TO TO

MONDAY SATURDAY SUNDAY FRIDAY THURSDAY WEDNESDAYTUESDAY

FROM FROM

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS DATE OF REQUESTED ACCESS (MM/DD/YYYY)

ISSUING STATE DRIVER'S LICENSE NUMBER

CITIZENSHIP COUNTRY OF BIRTH

PASSPORT NUMBER PLACE OF ISSUE

ALIEN REGISTRATION NUMBER PLACE OF ISSUE

VISA NUMBER PLACE OF ISSUE

DATE OF BIRTH (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATA REQUIRED BY THE PRIVACY ACT OF 1974

SECTION II. INFORMATION ON NON-U.S. CITIZEN APPLICANT(S)

a. SPONSOR'S LAST NAME, FIRST NAME, MIDDLE INITIAL

g. PURPOSE OF VISIT (Please provide details in the space provided below)

e. CONTRACT EXPIRATION DATE (CONTRACTORS ONLY)

c. SPONSOR'S ORGANIZATION

ACCESS ROSTER RENEWAL INITIAL REQUEST

d. DATE OF BIRTH (MM/DD/YYYY)

Mission Requirement Other

f. TYPE OF REQUEST (Select one only)

b. SPONSOR'S WORK PHONE (Area Code and Number)

SECTION I. SPONSOR'S INFORMATION (To be completed by the sponsor requesting personnel listed below for inclusion to the Installation Access Roster to permit entry to the U.S. Army, Presidio of Monterey, California. Sponsor will be responsible for all actions of their guests while on the installation).

AUTHORITY: Public Law 110-181, The 2008 National Defense Authorization Act, Section 109.

PRINCIPAL PURPOSE: Provide necessary information to determine if applicant meets the installation access requirements in accordance with the U.S. Army Garrison, Presidio of Monterey Command Policy # 17, Installation Access Procedures for Visitors. Use of Date of Birth, Driver's License number and Social Security Number (SSN) are necessary for positive identification of the applicant in the Department of Justice database. Use of SSN includes the full 9-digit or the last 4-digit only.

ROUTINE USE: National Crime Information Center Interstate Identification Index (NCIC III) criminal history check using the Department of Defense database.

DISCLOSURE IS VOLUNTARY: Disclosure of SSN and other information is voluntary. However, applicant's failure to provide full name, Date of Birth, Driver's License number, and SSN will result in a delay or denial of installation access. Sponsor's failure to provide Date of Birth and SSN when requesting a Defense Biometric Identification Data System (DBIDS) card for an applicant will result in denial of DBIDS card issue.

Enter Sponsor's Full SSN. This is required to verify enrollment in the Defense Enrollment Eligibility Reporting System (DEERS)

DBIDS CARD

Information collected in this form is FOR OFFICIAL USE ONLY. Sponsors will collect the required applicant information individually and not provide applicant access to each other's protected personal information. Once completed, if submitted via electronic mail using government computer, this application must be sent encrypted to the shared access email address: usarmy.pom.106-sig-bde.list.pres-installationaccess@army.mil. If using personal email, ensure that the security of your email system is adequate for sending sensitive information before choosing to transmit as this contains Personally Identifiable Information.

(FOR NON-U.S. CITIZEN APPLICANTS ONLY)

FOR APPROVING AUTHORITY USE ONLY

FOR LAW ENFORCEMENT USE ONLY

DATEPRINTED NAME SIGNATURE

POM Form 7-1, October 2015 PREVIOUS EDITION IS OBSOLETE Page 2 of 2

SECTION II. INFORMATION ON NON-U.S. CITIZEN APPLICANT(S) (Continuation page)

APPROVED

DISAPPROVED

DISQUALIFYING FACTORS

YES NO

3. LAST NAME, FIRST NAME, MIDDLE INITIAL

TO TO

MONDAY SATURDAY SUNDAY FRIDAY THURSDAY WEDNESDAYTUESDAY

FROM FROM

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS DATE OF REQUESTED ACCESS (MM/DD/YYYY)

ISSUING STATE DRIVER'S LICENSE NUMBER

CITIZENSHIP COUNTRY OF BIRTH

PASSPORT NUMBER PLACE OF ISSUE

ALIEN REGISTRATION NUMBER PLACE OF ISSUE

VISA NUMBER PLACE OF ISSUE

DATE OF BIRTH (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

4. LAST NAME, FIRST NAME, MIDDLE INITIAL

TO TO

MONDAY SATURDAY SUNDAY FRIDAY THURSDAY WEDNESDAYTUESDAY

FROM FROM

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS DATE OF REQUESTED ACCESS (MM/DD/YYYY)

ISSUING STATE DRIVER'S LICENSE NUMBER

CITIZENSHIP COUNTRY OF BIRTH

PASSPORT NUMBER PLACE OF ISSUE

ALIEN REGISTRATION NUMBER PLACE OF ISSUE

VISA NUMBER PLACE OF ISSUE

DATE OF BIRTH (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

5. LAST NAME, FIRST NAME, MIDDLE INITIAL

TO TO

MONDAY SATURDAY SUNDAY FRIDAY THURSDAY WEDNESDAYTUESDAY

FROM FROM

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS DATE OF REQUESTED ACCESS (MM/DD/YYYY)

ISSUING STATE DRIVER'S LICENSE NUMBER

CITIZENSHIP COUNTRY OF BIRTH

PASSPORT NUMBER PLACE OF ISSUE

ALIEN REGISTRATION NUMBER PLACE OF ISSUE

VISA NUMBER PLACE OF ISSUE

DATE OF BIRTH (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE OF ISSUE (MM/DD/YYYY)

DATE NCIC III CONDUCTED

(FOR NON U.S. CITIZEN APPLICANTS ONLY)

POM Form 7-1, October 2015 PREVIOUS EDITION IS OBSOLETE Page 1 of 2

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS

DATE OF REQUESTED ACCESS (MM/DD/YYYY)

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS

DATE OF REQUESTED ACCESS (MM/DD/YYYY)

DATA REQUIRED BY THE PRIVACY ACT OF 1974

SECTION II. INFORMATION ON NON-U.S. CITIZEN APPLICANT(S)

g. PURPOSE OF VISIT (Please provide details in the space provided below)

f. TYPE OF REQUEST (Select one only) SECTION I. SPONSOR'S INFORMATION (To be completed by the sponsor requesting personnel listed below for inclusion to the Installation Access Roster to permit entry to the U.S. Army, Presidio of Monterey, California. Sponsor will be responsible for all actions of their guests while on the installation).

AUTHORITY: Public Law 110-181, The 2008 National Defense Authorization Act, Section 109.

PRINCIPAL PURPOSE: Provide necessary information to determine if applicant meets the installation access requirements in accordance with the U.S. Army Garrison, Presidio of Monterey Command Policy # 17, Installation Access Procedures for Visitors. Use of Date of Birth, Driver's License number and Social Security Number (SSN) are necessary for positive identification of the applicant in the Department of Justice database. Use of SSN includes the full 9-digit or the last 4-digit only.

ROUTINE USE: National Crime Information Center Interstate Identification Index (NCIC III) criminal history check using the Department of Defense database.

DISCLOSURE IS VOLUNTARY: Disclosure of SSN and other information is voluntary. However, applicant's failure to provide full name, Date of Birth, Driver's License number, and SSN will result in a delay or denial of installation access. Sponsor's failure to provide Date of Birth and SSN when requesting a Defense Biometric Identification Data System (DBIDS) card for an applicant will result in denial of DBIDS card issue.

Information collected in this form is FOR OFFICIAL USE ONLY. Sponsors will collect the required applicant information individually and not provide applicant access to each other's protected personal information. Once completed, if submitted via electronic mail using government computer, this application must be sent encrypted to the shared access email address: usarmy.pom.106-sig-bde.list.pres-installationaccess@army.mil. If using personal email, ensure that the security of your email system is adequate for sending sensitive information before choosing to transmit as this contains Personally Identifiable Information.

APPLICATION FOR INSTALLATION ACCESS

(FOR NON-U.S. CITIZEN APPLICANTS ONLY)

FOR APPROVING AUTHORITY USE ONLY

FOR LAW ENFORCEMENT USE ONLY

POM Form 7-1, October 2015 PREVIOUS EDITION IS OBSOLETE Page 2 of 2 SECTION II. INFORMATION ON NON-U.S. CITIZEN APPLICANT(S) (Continuation page)

DISQUALIFYING FACTORS

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS

DATE OF REQUESTED ACCESS (MM/DD/YYYY)

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS

DATE OF REQUESTED ACCESS (MM/DD/YYYY)

DAYS REQUESTED ACCESS

TIME OF REQUESTED ACCESS

DATE OF REQUESTED ACCESS (MM/DD/YYYY)

DATE NCIC III CONDUCTED

8.0.1291.1.339988.308172