Visit_Authorization_Memo.pdf
PDF 165 KB Posted
- Attached to
- SMC/RSC VTC Upgrade Federal contract opportunity
- Solicitation number
- FA2543-19-R-0015
About this file
Site Visit Reservation Authorization Memo
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Text version
“FOR OFFICIAL USE ONLY”
DEPARTMENT OF THE AIR FORCE
460TH SPACE WING (AFSPC)
“The information herein is For Official Use Only (FOUO) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this
PERSONAL INFORMATION may result in criminal and/or civil penalties”
AMERICA’S MISSILE WARNING WING
Date: _________________
MEMORANDUM FOR 460 SFS/S5IV
FROM: SMC/RSC
SUBJECT: Visit Authorization for Short-notice or Emergency Visits to the Restricted Area
1. The below individual requires short-notice/emergency access to the restricted area.
DATE OF REQUEST VISIT DATES
NAME: (Last, First, MI) SSN
DATE & PLACE OF BIRTH CITIZENSHIP
CLEARANCE TYPE/DATE GRADE ORGANIZATION
PURPOSE OF VISIT POC/SPONSOR (Grade, Name, Off Sym, Phone)
2. Preannounced visitors are required to have two valid forms of identification. Valid forms of identification must be Federal or State issued. Visitor authorizations will only be accepted from the sponsoring agency and must be approved by an authorized signing official. Requests that do not contain all required information will not be processed and returned to the sponsoring agency.
Approval Authority Signature:__________________________________ Commander/Designated Representative
Printed Name/Title:__________________________________
Security Forces Authentication Signature:_________________________________ Printed Name/Title:
| Date: XX Jul 2019 |
| DATE OF REQUEST: XX Jul 2019 |
| VISIT DATES: 15 - 19 Jul 2019 |
| NAME Last First MI: Rabbit, Peter J. |
| SSN: 123-45-6789 |
| DATE PLACE OF BIRTH: 07/10/1990, Aurora, CO |
| CITIZENSHIP: US |
| CLEARANCE TYPEDATE: None |
| ORGANIZATION: Company Name |
| PURPOSE OF VISIT: Site Visit for VTC Upgrade |
| POCSPONSOR Grade Name Off Sym Phone: Larry G. Jackson,GS-12, SMC/RSC, 847-5411 or |
TSgt Jeremy Bushnell, SMC/RSL, 847-7723
| GRADE MIL/CIV: [CIV] |
| Printed NameTitle: Larry G. Jackson, Unit Security Manager |
| Printed NameTitle2: SSgt Wilson, Andre/NCOIC Pass & ID |
| Printed NameTitle3: : A1C Silvas, Cameron/Pass & ID Clerk |
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