Base Access Request (144 SFS DVES FORM 20240320)-Sponsor MSgt Sanchez.pdf
PDF 328 KB Posted
- Attached to
- Fire Suppression Test and Inspection
- Solicitation number
- W50S6T25QA018
- Issued by
-
Department of the Army National Guard
About this file
This is a Base Access Request Form used by the 144th Fighter Wing / Security Forces Squadron (SFS) to control physical access to the military installation for contractors, vendors, guests, and visitors.
The form requires sponsors to provide detailed information including their DOD ID number, rank/unit, contact information, and digital signature. For each visitor, the form collects personal data including full name, date of birth, citizenship, company/purpose of visit, and DBIDS (Defense Biometric Identification System) code. All visitors must pre-enroll in DBIDS at minimum 5 business days prior to their visit but no more than 30 days in advance. U.S. citizens require 5-10 business days for processing, while foreign nationals must submit requests at least 45 business days prior with passport and visa documentation. The form specifies required identification documents, visit duration, access days (Monday-Friday, Saturday, Sunday), location restrictions (base-wide, MSA, or other specified areas), and includes approval/denial sections for security forces use. The form is classified as Controlled Unclassified Information (CUI) and is protected under the Privacy Act of 1974, with a continuation sheet available for multiple visitors.
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Text version
144 FIGHTER WING / SFS
BASE ACCESS REQUEST FORM
Controlled Unclassified Information (CUI) : Protected under the Privacy Act of
SPONSOR'S LAST NAME, FIRST, MIDDLE / DOD ID NUMBER RANK OR GRADE / UNIT SPONSOR'S PHONE NUMBER DATE OF REQUEST
AFFILIATION TO SPONSOR REQUESTING OFFICE (I.E.CE, AMXS, MXS, LRS) OR PERSONAL VISITOR
SPONSOR EMAIL SPONSOR SIGNATURE
CONTRACT TITLE OR COMPANY START DATE OF VISIT END DATE OF VISIT ACCESS DAYS(REQUIRED)
MON-FRI SAT SUN
START-END TIME
PURPOSE OF VISIT:
LOCATION
BASE WIDE MSA OTHER:
REASON FOR ACCESS
CONTRACTOR VENDOR GUEST OTHER:
*All Visitors/Guests/Contractors must have their two (2) primary forms of identification used when pre-enrolling into DBIDS SITE DBIDS. No copies, photos or digital likenesses will be accepted. Processing is a minimum of 5-10 business days for all U.S. Citizens.
** Foreign Nationals must submit the information page of their passport with this form and visa (if applicable). Permanent Residents must submit a front and back copy of their resident card with this form. Permanent Residents are not considered U.S. Citizens. Foreign National Requests must be turned in at least 45 business days prior to arrival to ensure proper processing.
By Checking this box I understand the terms of sponsoring a guest/visitor/contractor to 144th Fighter Wing, CANG
CONTRACTOR/VENDOR/VISITOR INFORMATION
NAME (Last, First, Middle) Date of Birth
(YYYYMMDD) PURPOSE OR COMPANY (IF CONTRACTOR)
CITIZENSHIP
(EX: U.S., MEXICO,
GERMANY, ETC.)
DBIDS CODE
APPROVE/DENY
(SFS USE ONLY)
PASS AND REGISTRATION OFFICE USE ONLY
RECEIVED BY DATE RECEIVED
NCIC/NLETS: YES NO 144SECURITY FORCES REPRESENTATIVE
COMPLETED BY
AUTHORITY: DoDM5200.08v3_AFMAN31-101v3 Installation Perimeter Access Control, Title 18 U.S. Code Section 1382, “Entering military, naval, or Coast Guard property” and 144 FW Integrated Defense Plan PURPOSE(S): To control physical access to Department of Defense (DoD), Department of the Air Force (DOAF) or California Air National Guard Installations/Units controlled information, installations, facilities, or areas over which DoD, DOAF, or California Air National Guard has security responsibilities. DISCLOSURE: Providing registration information is voluntary.
Failure to provide requested information may result in denial of access to benefits, privileges, and DoD installations, facilities and buildings.
Pre-Enroll in the Defense Biometric Identification System (DBIDS) at https://dbids-global-enroll.dmdc.mil/preenrollui/#/landing-page, at minimum five(5) business days prior to and no more than (30) days prior to the day base access is requested. Use continuation sheet if necessary. Pass and Registration phone number 559-454-5243.
EXAMPLE: SMITH, JOHN, ROBERT 19740524 BASE TOUR U.S. ABC123
144 FIGHTER WING / SFS BASE ACCESS
REQUEST FORM FORM CONTINUATION SHEET
Controlled Unclassified Information (CUI) : Protected under the Privacy Act of 1974
SPONSOR'S LAST NAME, FIRST, MIDDLE/DOD ID NUMBER RANK/UNIT SPONSOR'S PHONE NUMBER DATE OF REQUEST
CONTRACTOR/VENDOR/SERVICE PROVIDER/VISITOR INFORMATION
NAME (Last, First, Middle) Date of Birth
(YYYYMMDD)
PURPOSE OR COMPANY (IF
CONTRACTOR)
CITIZENSHIP
(EX: U.S., MEXICO,
GERMANY, ETC.)
DBIDS CODE APPROVE/DENY
(SFS USE ONLY)
| SPONSORS LAST NAME FIRST MIDDLE DOD ID NUMBER: Sanchez, Jarrod, A |
| RANK OR GRADE UNIT: MSgt / MSG |
| SPONSORS PHONE NUMBER: 454-5129 |
| REQUESTING OFFICE IECE AMXS MXS LRS OR PERSONAL VISITOR: Contracting Office |
| SPONSOR EMAIL: jarrod.sanchez@us.af.mil |
| CONTRACT TITLE OR COMPANY: Site Visit |
| LOCATION: Site Visit |
| OTHER: |
| NAME Last First MiddleRow2: Last, First, Middle |
| Date of Birth YYYYMMDDRow2: YYYYMMDD |
| PURPOSE OR COMPANY IF CONTRACTORRow2: Site Visit - |
| US CITIZENRow2: U.S. |
| DBIDS CODERow2: # |
| APPROVEDENY SFS USE ONLYRow2: |
| NAME Last First MiddleRow3: |
| Date of Birth YYYYMMDDRow3: |
| PURPOSE OR COMPANY IF CONTRACTORRow3: |
| US CITIZENRow3: |
| DBIDS CODERow3: |
| APPROVEDENY SFS USE ONLYRow3: |
| NAME Last First MiddleRow4: |
| Date of Birth YYYYMMDDRow4: |
| PURPOSE OR COMPANY IF CONTRACTORRow4: |
| US CITIZENRow4: |
| DBIDS CODERow4: |
| APPROVEDENY SFS USE ONLYRow4: |
| NAME Last First MiddleRow5: |
| Date of Birth YYYYMMDDRow5: |
| PURPOSE OR COMPANY IF CONTRACTORRow5: |
| US CITIZENRow5: |
| DBIDS CODERow5: |
| APPROVEDENY SFS USE ONLYRow5: |
| NAME Last First MiddleRow6: |
| Date of Birth YYYYMMDDRow6: |
| PURPOSE OR COMPANY IF CONTRACTORRow6: |
| US CITIZENRow6: |
| DBIDS CODERow6: |
| APPROVEDENY SFS USE ONLYRow6: |
| NAME Last First MiddleRow7: |
| Date of Birth YYYYMMDDRow7: |
| PURPOSE OR COMPANY IF CONTRACTORRow7: |
| US CITIZENRow7: |
| DBIDS CODERow7: |
| APPROVEDENY SFS USE ONLYRow7: |
| NAME Last First MiddleRow8: |
| Date of Birth YYYYMMDDRow8: |
| PURPOSE OR COMPANY IF CONTRACTORRow8: |
| US CITIZENRow8: |
| DBIDS CODERow8: |
| APPROVEDENY SFS USE ONLYRow8: |
| NAME Last First MiddleRow9: |
| Date of Birth YYYYMMDDRow9: |
| PURPOSE OR COMPANY IF CONTRACTORRow9: |
| US CITIZENRow9: |
| DBIDS CODERow9: |
| APPROVEDENY SFS USE ONLYRow9: |
| NAME Last First MiddleRow10: |
| Date of Birth YYYYMMDDRow10: |
| PURPOSE OR COMPANY IF CONTRACTORRow10: |
| US CITIZENRow10: |
| DBIDS CODERow10: |
| APPROVEDENY SFS USE ONLYRow10: |
| NAME Last First MiddleRow11: |
| Date of Birth YYYYMMDDRow11: |
| PURPOSE OR COMPANY IF CONTRACTORRow11: |
| US CITIZENRow11: |
| DBIDS CODERow11: |
| APPROVEDENY SFS USE ONLYRow11: |
| NAME Last First MiddleRow12: |
| Date of Birth YYYYMMDDRow12: |
| PURPOSE OR COMPANY IF CONTRACTORRow12: |
| US CITIZENRow12: |
| DBIDS CODERow12: |
| APPROVEDENY SFS USE ONLYRow12: |
| Text28: |
| Text29: |
| Text31: |
| Check Box38: Yes |
| Check Box39: Yes |
| Check Box40: Off |
| Check Box41: Off |
| Check Box42: Off |
| Check Box43: Yes |
| Check Box44: Off |
| Check Box45: Off |
| Date46_af_date: 9:00 |
| Date48_af_date: |
| Check Box49: Yes |
| Check Box50: Off |
| Check Box51: Off |
| Date52_af_date: |
| Date53_af_date: |
| Dropdown1: [CIVILIAN CONTRACTOR] |
| Date2_af_date: |
| Check Box4: Off |
| Check Box5: Off |
| SPONSORS LAST NAME FIRST MIDDLEDOD ID NUMBER: |
| RANKUNIT: |
| SPONSORS PHONE NUMBER_2: |
| CONTRACTORVENDORSERVICE PROVIDERVISITOR INFORMATION: |
| NAME Last First MiddleRow1_2: |
| Date of Birth YYYYMMDDRow1_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow1_2: |
| US CITIZENRow1_2: |
| DBIDS CODERow1_2: |
| APPROVEDENY SFS USE ONLYRow1_2: |
| NAME Last First MiddleRow2_2: |
| Date of Birth YYYYMMDDRow2_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow2_2: |
| US CITIZENRow2_2: |
| DBIDS CODERow2_2: |
| APPROVEDENY SFS USE ONLYRow2_2: |
| NAME Last First MiddleRow3_2: |
| Date of Birth YYYYMMDDRow3_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow3_2: |
| US CITIZENRow3_2: |
| DBIDS CODERow3_2: |
| APPROVEDENY SFS USE ONLYRow3_2: |
| NAME Last First MiddleRow4_2: |
| Date of Birth YYYYMMDDRow4_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow4_2: |
| US CITIZENRow4_2: |
| DBIDS CODERow4_2: |
| APPROVEDENY SFS USE ONLYRow4_2: |
| NAME Last First MiddleRow5_2: |
| Date of Birth YYYYMMDDRow5_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow5_2: |
| US CITIZENRow5_2: |
| DBIDS CODERow5_2: |
| APPROVEDENY SFS USE ONLYRow5_2: |
| NAME Last First MiddleRow6_2: |
| Date of Birth YYYYMMDDRow6_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow6_2: |
| US CITIZENRow6_2: |
| DBIDS CODERow6_2: |
| APPROVEDENY SFS USE ONLYRow6_2: |
| NAME Last First MiddleRow7_2: |
| Date of Birth YYYYMMDDRow7_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow7_2: |
| US CITIZENRow7_2: |
| DBIDS CODERow7_2: |
| APPROVEDENY SFS USE ONLYRow7_2: |
| NAME Last First MiddleRow8_2: |
| Date of Birth YYYYMMDDRow8_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow8_2: |
| US CITIZENRow8_2: |
| DBIDS CODERow8_2: |
| APPROVEDENY SFS USE ONLYRow8_2: |
| NAME Last First MiddleRow9_2: |
| Date of Birth YYYYMMDDRow9_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow9_2: |
| US CITIZENRow9_2: |
| DBIDS CODERow9_2: |
| APPROVEDENY SFS USE ONLYRow9_2: |
| NAME Last First MiddleRow10_2: |
| Date of Birth YYYYMMDDRow10_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow10_2: |
| US CITIZENRow10_2: |
| DBIDS CODERow10_2: |
| APPROVEDENY SFS USE ONLYRow10_2: |
| NAME Last First MiddleRow11_2: |
| Date of Birth YYYYMMDDRow11_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow11_2: |
| US CITIZENRow11_2: |
| DBIDS CODERow11_2: |
| APPROVEDENY SFS USE ONLYRow11_2: |
| NAME Last First MiddleRow12_2: |
| Date of Birth YYYYMMDDRow12_2: |
| PURPOSE OR COMPANY IF CONTRACTORRow12_2: |
| US CITIZENRow12_2: |
| DBIDS CODERow12_2: |
| APPROVEDENY SFS USE ONLYRow12_2: |
| NAME Last First MiddleRow13: |
| Date of Birth YYYYMMDDRow13: |
| PURPOSE OR COMPANY IF CONTRACTORRow13: |
| US CITIZENRow13: |
| DBIDS CODERow13: |
| APPROVEDENY SFS USE ONLYRow13: |
| NAME Last First MiddleRow14: |
| Date of Birth YYYYMMDDRow14: |
| PURPOSE OR COMPANY IF CONTRACTORRow14: |
| US CITIZENRow14: |
| DBIDS CODERow14: |
| APPROVEDENY SFS USE ONLYRow14: |
| NAME Last First MiddleRow15: |
| Date of Birth YYYYMMDDRow15: |
| PURPOSE OR COMPANY IF CONTRACTORRow15: |
| US CITIZENRow15: |
| DBIDS CODERow15: |
| APPROVEDENY SFS USE ONLYRow15: |
| NAME Last First MiddleRow16: |
| Date of Birth YYYYMMDDRow16: |
| PURPOSE OR COMPANY IF CONTRACTORRow16: |
| US CITIZENRow16: |
| DBIDS CODERow16: |
| APPROVEDENY SFS USE ONLYRow16: |
| NAME Last First MiddleRow17: |
| Date of Birth YYYYMMDDRow17: |
| PURPOSE OR COMPANY IF CONTRACTORRow17: |
| US CITIZENRow17: |
| DBIDS CODERow17: |
| APPROVEDENY SFS USE ONLYRow17: |
| NAME Last First MiddleRow18: |
| Date of Birth YYYYMMDDRow18: |
| PURPOSE OR COMPANY IF CONTRACTORRow18: |
| US CITIZENRow18: |
| DBIDS CODERow18: |
| APPROVEDENY SFS USE ONLYRow18: |
| NAME Last First MiddleRow19: |
| Date of Birth YYYYMMDDRow19: |
| PURPOSE OR COMPANY IF CONTRACTORRow19: |
| US CITIZENRow19: |
| DBIDS CODERow19: |
| APPROVEDENY SFS USE ONLYRow19: |
| NAME Last First MiddleRow20: |
| Date of Birth YYYYMMDDRow20: |
| PURPOSE OR COMPANY IF CONTRACTORRow20: |
| US CITIZENRow20: |
| DBIDS CODERow20: |
| APPROVEDENY SFS USE ONLYRow20: |
| NAME Last First MiddleRow21: |
| Date of Birth YYYYMMDDRow21: |
| PURPOSE OR COMPANY IF CONTRACTORRow21: |
| US CITIZENRow21: |
| DBIDS CODERow21: |
| APPROVEDENY SFS USE ONLYRow21: |
| NAME Last First MiddleRow22: |
| Date of Birth YYYYMMDDRow22: |
| PURPOSE OR COMPANY IF CONTRACTORRow22: |
| US CITIZENRow22: |
| DBIDS CODERow22: |
| APPROVEDENY SFS USE ONLYRow22: |
| NAME Last First MiddleRow23: |
| Date of Birth YYYYMMDDRow23: |
| PURPOSE OR COMPANY IF CONTRACTORRow23: |
| US CITIZENRow23: |
| DBIDS CODERow23: |
| APPROVEDENY SFS USE ONLYRow23: |
| NAME Last First MiddleRow24: |
| Date of Birth YYYYMMDDRow24: |
| PURPOSE OR COMPANY IF CONTRACTORRow24: |
| US CITIZENRow24: |
| DBIDS CODERow24: |
| APPROVEDENY SFS USE ONLYRow24: |
| NAME Last First MiddleRow25: |
| Date of Birth YYYYMMDDRow25: |
| PURPOSE OR COMPANY IF CONTRACTORRow25: |
| US CITIZENRow25: |
| DBIDS CODERow25: |
| APPROVEDENY SFS USE ONLYRow25: |
| NAME Last First MiddleRow26: |
| Date of Birth YYYYMMDDRow26: |
| PURPOSE OR COMPANY IF CONTRACTORRow26: |
| US CITIZENRow26: |
| DBIDS CODERow26: |
| APPROVEDENY SFS USE ONLYRow26: |
| NAME Last First MiddleRow27: |
| Date of Birth YYYYMMDDRow27: |
| PURPOSE OR COMPANY IF CONTRACTORRow27: |
| US CITIZENRow27: |
| DBIDS CODERow27: |
| APPROVEDENY SFS USE ONLYRow27: |
| NAME Last First MiddleRow28: |
| Date of Birth YYYYMMDDRow28: |
| PURPOSE OR COMPANY IF CONTRACTORRow28: |
| US CITIZENRow28: |
| DBIDS CODERow28: |
| APPROVEDENY SFS USE ONLYRow28: |
| NAME Last First MiddleRow29: |
| Date of Birth YYYYMMDDRow29: |
| PURPOSE OR COMPANY IF CONTRACTORRow29: |
| US CITIZENRow29: |
| DBIDS CODERow29: |
| APPROVEDENY SFS USE ONLYRow29: |
| NAME Last First MiddleRow30: |
| Date of Birth YYYYMMDDRow30: |
| PURPOSE OR COMPANY IF CONTRACTORRow30: |
| US CITIZENRow30: |
| DBIDS CODERow30: |
| APPROVEDENY SFS USE ONLYRow30: |
| NAME Last First MiddleRow31: |
| Date of Birth YYYYMMDDRow31: |
| PURPOSE OR COMPANY IF CONTRACTORRow31: |
| US CITIZENRow31: |
| DBIDS CODERow31: |
| APPROVEDENY SFS USE ONLYRow31: |
| NAME Last First MiddleRow32: |
| Date of Birth YYYYMMDDRow32: |
| PURPOSE OR COMPANY IF CONTRACTORRow32: |
| US CITIZENRow32: |
| DBIDS CODERow32: |
| APPROVEDENY SFS USE ONLYRow32: |
| NAME Last First MiddleRow33: |
| Date of Birth YYYYMMDDRow33: |
| PURPOSE OR COMPANY IF CONTRACTORRow33: |
| US CITIZENRow33: |
| DBIDS CODERow33: |
| APPROVEDENY SFS USE ONLYRow33: |
| NAME Last First MiddleRow34: |
| Date of Birth YYYYMMDDRow34: |
| PURPOSE OR COMPANY IF CONTRACTORRow34: |
| US CITIZENRow34: |
| DBIDS CODERow34: |
| APPROVEDENY SFS USE ONLYRow34: |
| NAME Last First MiddleRow35: |
| Date of Birth YYYYMMDDRow35: |
| PURPOSE OR COMPANY IF CONTRACTORRow35: |
| US CITIZENRow35: |
| DBIDS CODERow35: |
| APPROVEDENY SFS USE ONLYRow35: |
| NAME Last First MiddleRow36: |
| Date of Birth YYYYMMDDRow36: |
| PURPOSE OR COMPANY IF CONTRACTORRow36: |
| US CITIZENRow36: |
| DBIDS CODERow36: |
| APPROVEDENY SFS USE ONLYRow36: |
| NAME Last First MiddleRow37: |
| Date of Birth YYYYMMDDRow37: |
| PURPOSE OR COMPANY IF CONTRACTORRow37: |
| US CITIZENRow37: |
| DBIDS CODERow37: |
| APPROVEDENY SFS USE ONLYRow37: |
| NAME Last First MiddleRow38: |
| Date of Birth YYYYMMDDRow38: |
| PURPOSE OR COMPANY IF CONTRACTORRow38: |
| US CITIZENRow38: |
| DBIDS CODERow38: |
| APPROVEDENY SFS USE ONLYRow38: |
| NAME Last First MiddleRow39: |
| Date of Birth YYYYMMDDRow39: |
| PURPOSE OR COMPANY IF CONTRACTORRow39: |
| US CITIZENRow39: |
| DBIDS CODERow39: |
| APPROVEDENY SFS USE ONLYRow39: |
| NAME Last First MiddleRow40: |
| Date of Birth YYYYMMDDRow40: |
| PURPOSE OR COMPANY IF CONTRACTORRow40: |
| US CITIZENRow40: |
| DBIDS CODERow40: |
| APPROVEDENY SFS USE ONLYRow40: |
| NAME Last First MiddleRow41: |
| Date of Birth YYYYMMDDRow41: |
| PURPOSE OR COMPANY IF CONTRACTORRow41: |
| US CITIZENRow41: |
| DBIDS CODERow41: |
| APPROVEDENY SFS USE ONLYRow41: |
| NAME Last First MiddleRow42: |
| Date of Birth YYYYMMDDRow42: |
| PURPOSE OR COMPANY IF CONTRACTORRow42: |
| US CITIZENRow42: |
| DBIDS CODERow42: |
| APPROVEDENY SFS USE ONLYRow42: |
| NAME Last First MiddleRow43: |
| Date of Birth YYYYMMDDRow43: |
| PURPOSE OR COMPANY IF CONTRACTORRow43: |
| US CITIZENRow43: |
| DBIDS CODERow43: |
| APPROVEDENY SFS USE ONLYRow43: |
| NAME Last First MiddleRow44: |
| Date of Birth YYYYMMDDRow44: |
| PURPOSE OR COMPANY IF CONTRACTORRow44: |
| US CITIZENRow44: |
| DBIDS CODERow44: |
| APPROVEDENY SFS USE ONLYRow44: |
| NAME Last First MiddleRow45: |
| Date of Birth YYYYMMDDRow45: |
| PURPOSE OR COMPANY IF CONTRACTORRow45: |
| US CITIZENRow45: |
| DBIDS CODERow45: |
| APPROVEDENY SFS USE ONLYRow45: |
| NAME Last First MiddleRow46: |
| Date of Birth YYYYMMDDRow46: |
| PURPOSE OR COMPANY IF CONTRACTORRow46: |
| US CITIZENRow46: |
| DBIDS CODERow46: |
| APPROVEDENY SFS USE ONLYRow46: |
| NAME Last First MiddleRow47: |
| Date of Birth YYYYMMDDRow47: |
| PURPOSE OR COMPANY IF CONTRACTORRow47: |
| US CITIZENRow47: |
| DBIDS CODERow47: |
| APPROVEDENY SFS USE ONLYRow47: |
| Date3_af_date: |
File details come from the government source that posted it. Updated .