Attch 4_JBLE Form 1_Visitors Pass Request.pdf

Section II: Access Details.

Section III: Visitor Center Use Only.

Section IV: Foreign Disclosure Office (FDO) and AFOSI use only.

Section V: Guest Information.

UNESCORTED ACCESS REQUEST

AUTHORITY: Title 10, United States Code 8012. PRINCIPAL PURPOSE: To assist security personnel in establishing a fitness determination through the identity proofing and vetting process. ROUTINE USES: To be utilized by personnel requesting to obtain guest installation access pass for unescorted access to Joint Base Langley/Eustis (JBLE) installations or for special one-time events. DISCLOSURE: Disclosure of the requested information is voluntary; however, failure to provide information may result in denial of request or the refusal by the Security Forces Squadron, Installation Access Control Section to permit access to the installation.

FOUO, This document contains information exempt from mandatory disclosure under the FOIA. Title 5 U.S.C. 552 (b) (6) applies.

This document also contains personal information that is protected by the Privacy Act of 1974 and must be safeguarded from unauthorized disclosure.

SPECIAL SECURITY REQUIREMENTS: IAW DoDM-5200.08 Volume 3, AFMAN 31-101 Volume 3, paragraph 1.1.g.(1)(b), It is the sponsoring organization's responsibility to ensure the visit is properly recorded and documented in the FVS, and the local AFOSI unit is coordinated with in advance of the official foreign visitors' arrival and prior to their departure from the installation. On the day of visit and when the FOREIGN VISITORS visitors have departed the installation, email AFOSI, at LANGLEYAFOSIREGION2.Det201CI.Counterintelligence@us.af.mil indicating time of arrival and departure from the installation.

Block 10. Time Frame

The following information has been provided to aid in the completion of the Unescorted Access Request.

Section I: Sponsor Information.

Block 6. Organization/Home Address (If you are sponsoring for a government purpose use your organization.

Block 1. Title The sponsors title (ie; Mr., Ms., Mrs., or associated rank of Military/GS employee).

Block 2. Last Name, First Name MI (Full name of sponsor, use format assigned).

Block 3. Duty Phone (Office number you can be reached at during business hours).

Block 4. Cell/Home Phone (Phone number you may be reached at during requested access times for your guests).

Block 5. DoD ID Number (Assigned number on your DoD ID Card-This is required to fully identify you in DBIDS).

If it is for personal reasons use your home address).

Block 7. Email Address (email submissions will be sent encrypted utilizing a .mil email address).

Block 8. Category for Access (Check the category of your guest).

Block 16. Fill in the blocks for all visitors 18 years of age or older.

IAW JBLE IDP all foreign request must be submitted to 633 SFS/VCC or 733 SFS/VCC seven (7) days in advance of the visit. The Sponsor signing below assumes responsibility while the individual is on base and must be on an Appointment Letter on file at the Visitor control Center. All individuals will be subjected to a Criminal History Background check.

Reminder: Badges must be returned to the Visitor Control Center upon termination of the contract or employment. If an extension is required, another form shall be completed. The individual(s) listed below has been thoroughly briefed on entry procedures and conduct while on Joint Base Langley-Eustis. Any violation or disruption of order will be reported to the sponsor by Security Forces member. Previously issued badges must be returned prior to re-issuance of a new badge.

Lost badges require a Letter of Lost Controlled Item prior to a replacement being issued.

Block 11. Reason for Access. Provide specific reason for access (ie; Meeting, Tow Truck, Pop-A-Lock, Taxi, Wedding, Family visit, etc…).

Block 12. Identify the Visiting Organization, Name of Event or if Contractor: Company Name (Prime and Sub Contractor), Contract Number, and Contract Period.

Block 13a, b, c: Sponsor completes each block. Must be legible when completed manually.

FOREIGN VISITORS must be submitted to 633 SFS/VCC (633SFS.S5P.VISITORCONTROLCENTER@us.af.mil) or 733 SFS/VCC (733MSG.S5T.VCC@us.af.mil) at least seven (7) days in advance for processing through AFOSI .

From Date (Start date of visit/contract, etc…) To Date (End date of visit/contract, etc…) From Time (Start time of visit or if continual access, start time each day) To Time (End time of visit or if continual access, end time each day) Days of Week (Days of week entry is required - If visiting select day(s) visit will take place, if continual access is required – actual days of work required to be present)

Block 9 Location (Check which location(s) in the JBLE area you are requesting your guests access to – Must be a valid need to enter these locations. Contractor/Vendors must provide contract number stating access locations are required).

JBLE Form 1, April 2023 Page 1 of 3

1. TITLE 2. NAME (Last, First, MI) 3. DUTY PHONE 4. ALTERNATE PHONE NUMBER 5. DOD ID

6. ORGANIZATION/HOME ADDRESS 7. EMAIL ADDRESS

II. ACCESS DETAILS

8. CATEGORY OF ACCESS 9. LOCATION 10. TIME PERIOD

Duty Days (Mon-Fri)

Weekends

Time Both (Sun-Sat)

Duty Hours (0800-1800)

After Hours (1800-0800)

Contractor

Vendor

Visitor, Long Term

Visitor/Volunteer

Foreign National

Other (Specify)

24-hours

11. REASON FOR ACCESS (Provide the specific reason access is being requested including contract work location.)

12. CONTRACTOR/SUBCONTRACTOR COMPANY OR SPECIAL EVENT NAME

13a. SPONSOR'S NAME, RANK, TITLE AND OFFICE SYMBOL 13b. SIGNATURE 13c. DATE

III. VISITOR CENTER USE ONLY

14a. DATE RECEIVED 14c. SEARCH PARAMETERS 14d. APPROVAL AND POSTING 14e. EAL Posted at:

NCIC Approved

14b. DATE VETTED VCIN Denied

AFJIS

15a. VERIFIED BY NAME, RANK, TITLE AND OFFICE SYMBOL 15b. SIGNATURE 15c. DATE

IV. Foreign Disclosure Office (FDO) and AFOSI use only 16a. CASE NAME 16b. VETTED DATE 16c. APPROVAL

Approved Denied

Both

From (date):

Thru (date):

UNESCORTED ACCESS REQUEST

I. SPONSOR INFORMATION

Langley AFB

Fort Eustis

JBLE Form 1, April 2023 Page 2 of 3

17c. DATE17b. SIGNATURE17a. VERIFIED BY NAME, RANK, TITLE AND OFFICE SYMBOL

VCC

Main Gate

Other (specify

V. GUEST INFORMATION

16. Enter information for all persons 18 years of age or older.

Name (Last, First MI) DOB Country of

Birth ID Type ID Number Country of

Issue State of Issue VCC Use Only

UNESCORTED ACCESS REQUEST

JBLE Form 1, April 2023 Page 3 of 3

1545401785A Cross-Out