Attachment 6 - Contractor Base Access Application.pdf
PDF 279 KB Posted
- Attached to
- Custodial Services at Altus AFB
- Solicitation number
- FA441926Q0002
About this file
This is a Defense Biometric Identification System (DBIDS) Card Application template for the 97th Air Mobility Wing (AETC) at Altus Air Force Base, Oklahoma. The form is used to request unescorted base access for contractor, vendor, or visitor personnel who need to conduct specified services on the installation.
The sponsor must complete the application identifying the individual's full name, date of birth, state and country of birth, physical descriptors (hair color, eye color, height, weight, race), residential address, driver's license/state ID number, Social Security number, and phone numbers. The sponsor specifies the dates of required access, required times (with days of week indicated), the company represented, and the nature of services to be performed. The sponsor certifies verification of the individual's need for base access and agrees to take responsibility for the sponsored individual, including ensuring return of the DBIDS card to Building 428/Visitor Center upon pass expiration or termination of duties. The sponsored individual must authorize a national criminal background check and acknowledge understanding that access denial does not constitute an admission of guilt. The application is valid for 30 days from the date of initiation. Special note applications for Windy Trails Golf Course, Rivers Elementary, or the Education Center are issued as Altus Passes. The form includes fields for issue date, expiration/denial date, FPCON status, and authorizing official signature.
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Text version
DEPARTMENT OF THE AIR FORCE
97THAIRMOBILITYWING (AETC)
ALTUS AIR FORCE BASE OKLAHOMA
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)
I am requesting to sponsor the below individual for unescorted entry into Altus AFB between
I am requesting to sponsor the below individual for unescorted entry into Altus AFB between
This person will be conducting this company
_____________ this company
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