Base Form Template.pdf

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Building 763 Air Duct Cleaning
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FA480025QA020
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This is a base access request form (JBLE Form 1) used for requesting unescorted access to Joint Base Langley/Eustis (JBLE) installations. The form requires detailed information about both the sponsor and visitors seeking access, including personal identification details, organizational information, and specific access requirements.

The form outlines several key requirements: Foreign visitors must submit requests 7 days in advance with passport copies and sponsor's DoD ID; all visitors must undergo criminal history background checks; EAL (Entry Authorization List) requests require 14-day advance submission; and foreign nationals must be escorted at all times. The form includes sections for sponsor information, access details (including location, time period, and reason for access), visitor center use, foreign disclosure office approval, and a roster for visitor information. Access can be requested for various categories including contractors, long-term visitors, regular visitors, foreign nationals, and special events, with options for different time periods (duty hours 0600-1900, after hours 1900-0600, or 24-hours) at either Langley AFB or Ft. Eustis locations.

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JBLE Form 1, May 2024 Page 1 of 3

BASE 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 have departed the installation, email AFOSI, at LANGLEYAFOSIREGION2.Det201CI.Counterintelligence@us.af.mil indicating time of arrival and departure from the installation. All must be escorted while on base.

IAW JBLE IDP all foreign request need to be submitted with scanned copies of the passport and front/back of the sponsor's DoD issued ID card to the 633 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. All EAL Requests will be submitted 14 days in advance of the event.

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.

The following information has been provided to aid in the completion of the Access Request. Section I:

Sponsor Information.

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). Block 6.

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

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).

Section II: Access Details.

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

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).

Block 10. Time Frame 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 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.

Section III: Visitor Center Use Only.

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

Guest Information.

FOREIGN VISITORS must be submitted to 633 SFS/VCC (633SFS.S5P.VISITORCONTROLCENTER@us.af.mil) at least seven (7) days in advance for processing through AFOSI . Block 16.

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

mailto:LANGLEYAFOSIREGION2.Det201CI.Counterintelligence@us.af.mil

JBLE Form 1, May 2024 Page 2 of 3

BASE ACCESS REQUEST

I. SPONSOR INFORMATION

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

Contractor

Visitor, Long Term

Visitor

Foreign National (must be always escorted)

Other

EAL (Specify)

9. LOCATION

Langley AFB

10. TIME PERIOD

From (DD/MM/YY):

Thru (DD/MM/YY):

Time

Duty Hours (0600-1900)

After Hours (1900-0600)

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

NCIC

VCIN

14d. APPROVAL AND POSTING

Approved

Denied

14e. EAL Posted at:

VCC

All Gates 14b. DATE VETTED

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

17a. VERIFIED BY NAME, RANK, TITLE AND OFFICE SYMBOL 17b. SIGNATURE 17c. DATE

Monday to Friday

Weekends Only

Sunday to Saturday

Ft. Eustis

1283936623A Highlight

JBLE Form 1, May 2024 Page 3 of 3

Name (Last, First MI)

DOB

DD/MM/YY ID Type Country STATE ID Number VCC Use Only

1 TITLE:
2 NAME Last First MI:
3 DUTY PHONE:
4 ALTERNATE PHONE NUMBER:
5 DOD ID:
6 ORGANIZATIONHOME ADDRESS:
7 EMAIL ADDRESS:
11 REASON FOR ACCESS Provide the specific reason access is being requested including contract work location_2:
12 CONTRACTORSUBCONTRACTOR COMPANY OR SPECIAL EVENT NAME:
13a SPONSOR S NAME RANK TITLE AND OFFICE SYMBOL:
13c DATE:
15a VERIFIED BY NAME RANK TITLE AND OFFICE SYMBOL_2:
15c DATE:
16a CASE NAME:
17a VERIFIED BY NAME RANK TITLE AND OFFICE SYMBOL:
17c DATE:
DOBRow1:
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