Contractor Pass Request-Template.docx

DEPARTMENT OF THE AIR FORCE

20th FIGHTER WING (ACC)

SHAW AIR FORCE BASE SOUTH CAROLINA

DATE:

TO: 20 SFS / S-5, Visitor Control Center, 895-9085/86 (NOTE: For encryption purposes send to, SSgt Cook: natalie.cook@us.af.mil , SrA Evans: troy.evans.7@us.af.mil, SrA Slone: austin.slone@us.af.mil, Robert Bahre: Robert.Bahre.3@us.af.mil)

FROM: 20th Contracting Squadron/PKB Point of Contact: SrA Dillon Johnson Comm: (803) 895-9133 / DSN 9133

SUBJECT: Contractor(s) needing access to Shaw

COMPANY NAME:

WHAT FOR:

WHERE:

WHEN (dates, days and times):

SPONSOR INFO:

SrA Dillon Johnson, Contract Specialist 20th Contracting Squadron/PKB, DSN: 9133 / Comm: (803) 895-9133 DAY PAPER PASS (good for one year): X YES OR NO

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 lose privileges and face criminal charges.

NAMES SSN DOB ST-DL NO. US CITIZEN

I UNDERSTAND THAT AS SPONSOR, I AM RESPONSIBLE FOR THE PERSON(S) LISTED ON THIS FORM AND FOR ENSURING THE ABOVE NAME INDIVIDUAL(S) TURN(S) IN PASS OR RETRIEVE IT ONCE THE INDIVIDUAL(S) ARE TERMINATED, QUIT, OR NO LONGER REQUIRES ACCESS. IF I AM NOT ABLE TO RETRIEVE IT, I WILL NOTIFY SECURITY FORCES ISSUING AUTHORITY TO HAVE THE INDIVIDUAL(S) PASS DEACTIVATED.

This form must be Authenticated and received through 20sfs.backgroundchec@us.af.mil from the actual sponsor’s email account, with the understanding that by submitting this form sponsor agrees to all conditions implied on this form. To encrypt the form for security of PII it must be sent to Robert.Bahre.3@us.af.mil; troy.evans.7@us.af.mil; austin.slone@us.af.mil.

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