Base Access Form.pdf
PDF 431 KB Posted
- Attached to
- B1997 RAPCON Facility Security System
- Solicitation number
- FA480326Q0077
About this file
Summary of Shaw Air Force Base Contractor Access Request Form
This is a Memorandum for Record and form template from the 20th Fighter Wing (ACC) at Shaw Air Force Base, South Carolina, used to process Criminal Background History Checks for contractors and employees requiring base access. The form must be submitted by a government sponsor from their official Air Force email to the 20 SFS/S-5V office (Security Forces Visitor Control) at the designated email addresses or fax number. Completed requests receive confirmation emails with further instructions. The form is marked as Controlled Unclassified Information (CUI) and governed by the Privacy Act of 1974.
The request form requires the sponsor to provide specific information including the requestor's full legal name, date of birth, Social Security number, state driver's license number (with REAL ID status), and U.S. citizenship status. The sponsor must also identify the purpose of access (construction, new hire, job interview, site visit, CAC renewal, etc.), specific location(s) on base, exact dates and hours of access needed, and complete contact information including DOD EDPI number and government email. Visitors must comply with Real ID Act identification requirements or possess a Federal ID to receive a visitor pass from the Visitor Control Center. The sponsor assumes full responsibility for ensuring visitors return passes upon termination or completion of access needs and must notify Security Forces for pass deactivation in the DBIDS system if unable to retrieve passes personally. Non-U.S. citizens must submit supporting documentation (visa, permanent resident card, employment authorization card) prior to visiting the base.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
DEPARTMENT OF THE AIR FORCE
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
CUI
Victory By Valor
CUI
CUI
DATE: XX/XX/XXXX
MEMORANDUM FOR 20 SFS/S-5V:
(email to: BOTH Ms. Jacqueline Hernandez-Sears jacqueline.hernandez-sears.1@us.af.mil, SSgt Austin Simerly austin.simerly@us.af.mil, and Mr. Joshua
Arbeiter joshua.arbeiter.2@us.af.mil 803-895-9085 or 803-895-9086/ VCC Email: udg_20sfs_vcc@us.af.mil)
This form MUST BE SENT BY THE SPONSOR listed from their government email and received at the email addresses/fax number listed above in the 20 SFS/S-5V section and will receive a confirmation email once completed with instructions.
FROM: (The person requesting background check be conducted and squadron/unit)
SUBJECT: (i.e Contractor/Employee needing access to Shaw AFB)
WHO: (Company or Organization the Contractor/Employee will be working for)
WHAT FOR: (i.e Construction, New Hire, Job Interview, Meeting, New CAC or CAC Renewal, Work order etc.)
WHERE: (Location Contractor/Employee will be working at or needing access to)
If base wide give justification: (i.e Individual needs access to multiple buildings on base)
WHEN: (The exact day/dates and hours the individual will need access to the base (i.e. May 10, 2022, 0800-1700hrs or from May 10, 2022- May 10, 2023 Monday-Saturday, 0700-1900hrs)
SPONSOR: (The CAC holding individual responsible for the individual listed below and their organization) DOD EDPI: The # on the back of you CAC
CONTACT INFO: (Sponsor’s GOV email and PHONE NUMBER W/EXTENSION)
The information below is protected under Privacy Act 1974 and will only be used to process Criminal Background History Checks to grant or deny access to Shaw AFB. It is further understood that anyone abusing approved privileges could, at a minimum, lose said privilege and possibly face criminal charges.
Full Legal Name (Last, First MI)
Date Of Birth (Year/Mo/Day)
Social Security Number
ST-DL #
(REAL ID Y/N)
U.S.
Citizen (Y/N)
DOE, JOHN E. 1995/01/01 123-45-6789 SC-12345678 Y Y
********IF UNDER THE AGE OF 18, PLEASE COMPLETE A SEPARATE WORK REQUEST. *********
DO NOT FILL THIS PAGE PLEASE USE THE NEXT PAGE
mailto:jacqueline.hernandez-sears.1@us.af.mil mailto:austin.simerly@us.af.mil
DEPARTMENT OF THE AIR FORCE
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
CUI
Victory By Valor
CUI
CUI
DATE: 31-July-26
MEMORANDUM FOR 20 SFS/S-5V
FROM: 20th CONS
SUBJECT: Contractors need base access for site visit
WHO: Interested Vendors
WHAT FOR: Site Visit at Building 1997
WHERE: Building 1997
(If base wide give justification)
WHEN: 7 August 2026 @ 1000
SPONSOR NAME:
DOD EDPI:
CONTACT INFO:
The information below is protected under Privacy Act 1974 and will only be used to process Criminal Background History Checks to grant or deny access to Shaw AFB. It is further understood that anyone abusing approved privileges could, at a minimum, lose said privilege and possibly face criminal charges.
PLEASE READ THE STATEMENTS BELOW
1. I UNDERSTAND THAT AS THE SPONSOR I AM RESPONSIBLE FOR THE PERSON(S) LISTED ON THIS FORM, AND FOR ENSURING THE ABOVE NAME INDIVIDUAL(S) TURNS IN THE DBIDS PASS OR RETRIEVE THE PASS ONCE THE INDIVIDUAL(S) ARE TERMINATED, QUIT, OR NO LONGER REQUIRES ACCESS. IF I AM NOT ABLE TO RETRIEVE
THE PASS, I WILL NOTIFY SECURITY FORCES TO HAVE THE INDIVIDUAL(S) PASS DEACTIVATED IN DBIDS.
2. If you, as the sponsor, filled out the request and answered N for U.S Citizen please make sure you submit scanned in documents before coming to the VCC. **i.e.-FOREIGN VISA, PERMANENT RESIDENT CARD (Form I-551) & EMPLOYMENT AUTHORIZATION CARD (Form I-766) HOLDERS, ETC.
3. AS THE SPONSOR, I will inform my visitors they must have identification in compliance with the Real ID Act OR have a Federal ID in which cases they do not. If they do not, they will not be able to receive a pass from the VCC.
Full Legal Name (Last, First MI)
Date Of Birth (Year/Mo/Day)
Social Security Number
ST-DL #
(REAL ID Y/N)
U.S.
Citizen (Y/N)
File details come from the government source that posted it. Updated .