Base Access Request.docx
DOCX document 18 KB Posted
- Solicitation number
- FA301626Q0050
About this file
This is a Base Access Request Form used to process security clearance and facility access for contractor personnel working on Air Force contracts. The form must be completed for each individual contractor employee requiring base access and submitted to the Contract Specialist (Shannon Mansfield) and Contracting Officer (Umar Thomas) at the Department of the Air Force Air Education and Training Command.
The form requires collection of personally identifiable information (PII) including full name, date of birth, country of birth, driver's license number and state of issue, cell phone, email address, and US citizenship status for up to five contractor personnel. The form explicitly notes that non-US contractor personnel will require additional security vetting and processing delays. All personnel must have no outstanding traffic warrants or other legal disqualifications. Due to the sensitive nature of PII contained in pass requests, contractors must password-protect completed forms and provide passwords separately to both the Contract Specialist and Contracting Officer for processing verification.
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Text version
BASE ACCESS REQUEST FORM
Please fill out the form below and return to Contract Specialist: Shannon Mansfield, Email: shannon.mansfield@us.af.mil and Umar Thomas, Contracting Officer Email: umar.thomas.1@us.af.mil. NOTE: Due to additional security vetting requirements and associated processing timelines non-US contractor pass requests will require added information and additional delays. ADDED NOTE: Please ensure personnel have no outstanding traffic warrants or other legal issues that would disqualify them from base access.
Contractor 1
Company Name:
Last Name, First Name, MI
Cell Phone Number
Email Address:
DOB: (DD/MMM/YY):
Country of Birth:
Driver’s License Number:
State of Issue:
| US CITIZEN | |
| YES | NO |
Contractor 2
Company Name:
Last Name, First Name, MI
Cell Phone Number
Email Address:
DOB: (DD/MMM/YY):
Country of Birth:
Driver’s License Number:
State of Issue:
| US CITIZEN | |
| YES | NO |
If individual does not have a Driver’s License, then please provide the type of ID document and Number. Since Pass requests contains PII information, please password protect the above Base Pass information and submit password to both the Contract Specialist and Contracting Officer for processing. Confirm Government Receipt of Your Pass Request Documents.
Contractor 3
Company Name:
Last Name, First Name, MI
Cell Phone Number
Email Address:
DOB: (DD/MMM/YY):
Country of Birth:
Driver’s License Number:
State of Issue:
| US CITIZEN | |
| YES | NO |
Contractor 4
Company Name:
Last Name, First Name, MI
Cell Phone Number
Email Address:
DOB: (DD/MMM/YY):
Country of Birth:
Driver’s License Number:
State of Issue:
| US CITIZEN | |
| YES | NO |
Contractor 5
Company Name:
Last Name, First Name, MI
Cell Phone Number
Email Address:
DOB: (DD/MMM/YY):
Country of Birth:
Driver’s License Number:
State of Issue:
| US CITIZEN | |
| YES | NO |
File details come from the government source that posted it. Updated .