B.08 Attachment 7 - Entry Authorization Form.pdf
PDF 113 KB Posted
- Attached to
- Construct VM/AGE Complex Federal contract opportunity
- Solicitation number
- W50S8W25RA003
- Issued by
- Department of the Army National Guard
About this file
This is an Entry Authority List (EAL) form used to collect information for entry control to the 153d Airlift Wing. The form (153AW Form 12, 20200701) is a standardized template that allows for listing up to 12 individuals who need access to the installation for specific business functions not associated with contracts.
The form requires detailed information including the description and location of business/function, inclusive dates, and a point of contact with their phone number and unit. For each visitor, the form captures their full name, date of birth, driver's license number, and state of issue. The form includes a Privacy Act Statement citing USC Title 10, 8013 as authority, and specifies that the information will not be disclosed outside the Department of Defense. All listed individuals must be escorted by the designated Point of Contact. The form must be authenticated by Security Forces Squadron (SFS) personnel with their signature and date before access is granted.
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Text version
ENTRY AUTHORITY LIST (EAL)
PRIVACY ACT STATEMENT: 1. AUTHORITY: USC Title 10, 8013 2. PURPOSE: Used to collect information needed for entry control to the 153d Airlift Wing.
3. ROUTINE USES: This information will not be disclosed outside the Department of Defense. 4. DISCLOSURE: Voluntary. However, failure to provide information results in the denial of entry to the 153d Airlift Wing. Mail to:153.AW.Entry.Authority.List@us.af.mil
The following individuals will be on the installation for the listed function/business and dates stated. All individuals listed will be escorted at all times by the Point of Contact for this EAL. This EAL is used for business/functions not associated with contracts.
DESCRIPTION OF BUSINESS/FUNCTION: LOCATION OF BUSINESS/FUNCTION INCLUSIVE DATES:
POINT OF CONTACT: (Last, First, MI) PHONE #: UNIT: DATE SUBMITTED:
#1. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#2. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#3. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#4. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#5. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#6. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#7. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#8. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#9. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#10. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#11. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
#12. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:
AUTHENTICATED BY SFS: (LAST, FIRST, MI) AUTHENTICATED BY SFS: (SIGNATURE) DATE:
153AW FORM 12, 20200701 PREVIOUS EDITIONS OBSOLETE
mailto:153.AW.Entry.Authority.List@us.af.mil mailto:153.AW.Entry.Authority.List@us.af.mil
| ENTRY AUTHORITY LIST EAL: |
| The following individuals will be on the installation for the listed functionbusiness and dates stated All individuals listed will be escorted at all times by the Point of Contact for this EAL This EAL is used for businessfunctions not associated with contractsRow1: |
| DESCRIPTION OF BUSINESSFUNCTIONRow1: |
| LOCATION OF BUSINESSFUNCTIONRow1: |
| INCLUSIVE DATESRow1: |
| POINT OF CONTACT Last First MIRow1: |
| PHONE Row1: |
| UNITRow1: |
| DATE SUBMITTEDRow1: |
| 1 NAME Last First MI: |
| 1 NAME Last First MIRow1: |
| DATE OF BIRTHRow1: |
| DRIVER LICENSE Row1: |
| STATE OF ISSUERow1: |
| 2 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_2: |
| DRIVER LICENSE Row1_2: |
| STATE OF ISSUERow1_2: |
| 3 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_3: |
| DRIVER LICENSE Row1_3: |
| STATE OF ISSUERow1_3: |
| 4 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_4: |
| DRIVER LICENSE Row1_4: |
| STATE OF ISSUERow1_4: |
| 5 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_5: |
| DRIVER LICENSE Row1_5: |
| STATE OF ISSUERow1_5: |
| 6 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_6: |
| DRIVER LICENSE Row1_6: |
| STATE OF ISSUERow1_6: |
| 7 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_7: |
| DRIVER LICENSE Row1_7: |
| STATE OF ISSUERow1_7: |
| 8 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_8: |
| DRIVER LICENSE Row1_8: |
| STATE OF ISSUERow1_8: |
| 9 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_9: |
| DRIVER LICENSE Row1_9: |
| STATE OF ISSUERow1_9: |
| 10 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_10: |
| DRIVER LICENSE Row1_10: |
| STATE OF ISSUERow1_10: |
| 11 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_11: |
| DRIVER LICENSE Row1_11: |
| STATE OF ISSUERow1_11: |
| 12 NAME Last First MIRow1: |
| DATE OF BIRTHRow1_12: |
| DRIVER LICENSE Row1_12: |
| STATE OF ISSUERow1_12: |
| AUTHENTICATED BY SFS LAST FIRST MI: |
| AUTHENTICATED BY SFS LAST FIRST MIRow1: |
| DATERow1: |
| 153AW FORM 12 20200701: |
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