Base Access-Template.pdf
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- Attached to
- FA480326Q0025 - LRS Shelving Units
- Solicitation number
- FA480326Q0025
About this file
This document is a memorandum and access request form used by the Department of the Air Force, 20th Fighter Wing at Shaw Air Force Base, South Carolina, to process criminal background history checks for contractors and employees requiring base access.
The form serves as a template for requesting base access for visitors and contractors. The sponsor (a CAC-holding Air Force employee) must submit the request via government email to the 20 SFS/S-5V office with specific recipient addresses provided. Key required information includes: the requester's name and squadron/unit, the contractor/employee's full legal name, date of birth, Social Security number, state driver's license number (noting REAL ID compliance), U.S. citizenship status, the company or organization the individual represents, the purpose of access (e.g., construction, site visit, new hire, job interview, CAC renewal), specific building locations needed, exact dates and hours of access required, and the sponsor's contact information including government email and phone number with extension. The form explicitly states that individuals under 18 years old require a separate work request. For non-U.S. citizens, sponsors must submit scanned documentation including foreign visas, Permanent Resident Cards (Form I-551), or Employment Authorization Cards (Form I-766) before the site visit. All visitors must possess identification compliant with the REAL ID Act or hold a Federal ID to receive a visitor pass from the Visitor Control Center. The form is marked as CUI (Controlled Unclassified Information) and emphasizes that information is protected under the Privacy Act of 1974.
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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: 23-APR-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 216 and 1518
WHERE: Building 216 and Building 1518
(If base wide give justification)
WHEN: 1 May 2026 at 1:00 PM EST
SPONSOR NAME: SrA Tessa Steward
DOD EDPI:
CONTACT INFO: tessa.steward@us.af.mil
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 .