Attachment 04. UPDATED JB CHS Form 111 Contractor Access Worksheet .pdf

This is a Contractor Access Worksheet and Pass Procedures form used by Joint Base Charleston (JB CHS) to collect personal and access information from contractors and subcontractors requiring regular or frequent base access for performance of official duties under Air Force contracts.

The form consists of three main sections. Section A collects applicant information including name, driver's license number, date of birth, Social Security number, phone, current address, and signature. Section B requests access-specific details such as company name, days and times access is needed, access start and end dates, physical locations on base, and badge type. Section C captures sponsor information including the sponsor's name, organization, phone number, Department of Defense ID, and signature. The procedures outline application requirements including that applications must be typed or handwritten with wet or digital signatures; requested start dates may be up to 30 calendar days before or after the turn-in date, and the pass will be issued on the actual pass date. Temporary passes for less than 40 hours per week are issued in 29-day increments. An NCIC background check will be conducted based on provided information. The form includes a detailed criminal history evaluation table specifying years since conviction for various offenses (ranging from warrants to misdemeanors) with corresponding point values that determine access denial or approval. A copy of the applicant's front and back driver's license or real ID compliant identification must be attached.