Contractor Application For Base Access (10).pdf

DDEPARTMENTT OFF THEE AIRR FORCE

97TH AIR MOBILITY WING (AETC)

ALTUSS AIRR FORCEE BASEE OKLAHOMAA

Notes: Application is only valid for 30 days after date of initiation. Issue Date of Pass: ____________________________ If this is for Windy Trails Golf Course, Rivers Elementary, Expiration/Denial Date: ________________________ or Education Center, then this will be made as an Altus Pass. FPCON Granted: _____________________________

Issued/Denied By: ____________________________ Approved/Denied until: ________________________

MEMORANDUM FOR 97 SFS/S5D

FROM: _________________________________ (Sponsor)

SUBJECT: Altus Air Force Base (AAFB) Defense Biometric Identification System (DBIDS) Card Application

1. I am requesting to sponsor the below individual for unescorted entry into Altus AFB between the following dates _________ - _________. This person will be conducting these services while on Altus AFB:

___________________________________________ for this company _________________________.

He/she requires base access during these times ________ - ________ and the days checked below:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Full Name: ________________________________________________________________

Date of Birth: ______________ State of Birth: _________ Country of Birth: ________________

Hair Color: _______ Eye Color: ________ Height: _____” Weight: ______lbs

Race: Caucasian African American Asian Hispanic

Other (specify): _______________________

Address: Apt #: _____ Street: __________________________ City: ________________

State: ____ Zip/Postal Code #: ____________________

Driver’s License/State ID #: ________________________________ SSN: ____________________

Cell/Home Phone #: __________________ Work/Supervisor’s #: _________________

2. I am sponsoring this person on behalf of ________________________________ (organization). Upon expiration of the pass, termination of their duties, or I am no longer sponsoring this individual, I will ensure my sponsored individual returns their card to Bldg #428/Visitor Center.

3. If there are any questions or concerns in regards to this application or sponsored individual, I can be contacted at my cell/work #: ___________ and/or e-mail at: _________________________. By signing this memorandum I have verified this person’s need for access to the installation and agree to take responsibility of this individual.

(Sponsor’s Signature)

1st Ind, _________________________ (Sponsored Individual’s First & Last Name)

MEMORANDUM FOR 97 SFS/S5D

I authorized the use and release of my personal information to Altus AFB, Oklahoma, to accomplish a national criminal background check to determine my ability to access Altus AFB. If I am denied access to the installation my signature below will constitute as my acknowledgement and is not an admission of guilt. I will receive a copy of this memorandum if denied.

(Sponsored Individual’s Signature)

Full Name:

Date of Birth: State of Birth: Country of Birth:

Hair Color: Eye Color: Height: Weight:

Race:

Address:

Driver’s License/State ID #:

Cell/Home Phone #: Work/Supervisor’s #:

SSN:

(Sponsored Individual’s Signature) g p q p

_____ p