Contractor Badge Application.docx
DOCX document 9 KB Posted
- Attached to
- MEMPHIS LODGING
- Solicitation number
- W912L726Q0502
About this file
The provided document is a Contractor Badge Worksheet used for determining installation entry suitability for contractors. The form requires comprehensive personal and professional information, including full name, Social Security Number, date of birth, home address, physical characteristics, driver's license details, company information, vehicle information, and authorization for background investigations.
The worksheet is designed to collect detailed identifying information for contractor access, with spaces for NCIC (National Crime Information Center) results, driver's license verification, sponsor details, and official badge issuance. The document emphasizes that providing accurate information is voluntary but failure to do so may result in installation entry denial. Notably, the form allows for background checks and disclosure of information to local, county, state, and federal law enforcement agencies, with the primary purpose of positively identifying individuals seeking installation access.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 194th Mission HOTEL ROSTER hotel.xlsx | XLSX spreadsheet | |
| 164th SFS FORM 10 CONTRACTORS.pdf | ||
| PWS 194TH UNITS Lodging OCT 2025 (1).rtf | RTF text file | |
| W912L726Q0502 MEMPHIS Combined Synopsis lodging.docx | DOCX document |
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
CONTRACTOR’S BADGE WORKSHEET-
EXTENDED
| ISSUE DATE |
| EXP DATE |
| BADGE NO. |
AUTHORITY: 10 U.S.C. 8013; 44 U.S.C. 3101; and E0 9397 PURPOSE: Used to record information and details to determine installation entry suitability.
ROUTINE USES: Information may be disclosed to local, county, state and federal, law enforcement/investigative authorities or agencies.
DISCLOSURE IS VOLUNTARY: The Social Security Number is used to positively identify the individual. Failure to provide information on this form, or failure to provide true and correct information, may result in installation entry denial or other possible lawful actions.
CONTRACTOR’S INFORMATION
| NAME (LAST, FIRST MI.) |
| GENDER(M/F) |
| SSN |
| D.O.B. |
| HOME ADDRESS |
| CITY |
| STATE |
| ZIP CODE |
| PHONE |
| DRIVER’S LICENSE (NUMBER, STATE) |
| RACE |
| HEIGHT |
| WEIGHT |
| HAIR COLOR |
| EYE COLOR |
COMPANY INFORMATION
| COMPANY/EMPLOYER |
| ADDRESS |
| CITY |
| STATE |
| PHONE |
VEHICLE INFORMATION
| TAG # |
| MAKE |
| MODEL |
| COLOR |
| YEAR |
| INSURANCE COMPANY |
BACKGROUND INVESTIGATION RESULTS
I authorize without reservation, any party or agency contacted to furnish any information about criminal convictions, motor vehicle, and other reports be released from any liability and responsibility for doing so. This authorization and consent shall be valid in original or electronic form.
| DATE |
| NCIC RESULTS |
| DRIVER’S LICENSE RESULTS |
| NCIC ADMINISTRATOR (Signature) |
SPONSOR
| NAME (LAST, FIRST MI.) |
| UNIT |
| PHONE |
| LOCATION OF WORK |
ADDITIONAL REMARKS
| CONTRACTOR SIGNATURE |
| BADGE ISSUING OFFICIAL (PRINTED NAME) |
| BADGE ISSUING OFFICIAL (Signature) |
FOR OFFICIAL USE ONLY
File details come from the government source that posted it. Updated .