J21_EAL_Template.xlsx

XLSX spreadsheet 21 KB Posted Nov 14, 2016

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J21 - Entry Access List (EAL)

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EAL Blank Template

	Last, First, Middle Initial	Gender M/F	DOB (year month day)	Drivers License Number/State	State of Issue	Company Name	Nationality/Passport #/Visa #/INS # (if non us citizen)	Place of citizenship /Place of Birth	Citizenship date (if naturalized citizen)	Foreign continuous or routine contacts (name, country, relationship/method of contact) (list all)
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PRIVACY ACT STATEMENT Authority: 10 U.S.C. 8013 and Executive Orders 13478 and 9397 as amended (SSN). Purpose: Information collected by PMO Security will be used to authorize
installation entry to persons shown on the entry authority listing for the specific purpose provided by the sponsor. Information will also be used to notify person(s) designated as the visitor
sponsor of arrival and other pertinent information relating to entry on the installation. Routine Uses: Records may be disclosed to applicable Federal, State, or local agency charged with the
responsibility of investigating or prosecuting a violation or enforcing/implementing a statute, rule, regulation, order issued pursuant thereto.
Disclosure: Disclosure of requested information is voluntary. Failure to provide all or parts of information requested can result in denial of installation entry. System of records number
F031 AF SF B, applies. Security Forces Management Information System (SFMIS)

CONTRACTOR PERSONAL INFORMATION LIST FOUO FA4600-16-R-0010

Attachment 21

File details come from the government source that posted it. Updated Nov 14, 2017.