Attachment_5_EAL_Base_Pass_Request.pdf

DATE:

TO: 20 SFS / S-2, Investigations, 895-3600

FROM: 20/CONS

SUBJECT: Contractor(s) needing access to Shaw

COMPANY NAME:

WHAT FOR:

WHERE:

WHEN:

SPONSOR INFO:

DAY PAPER PASS (good for one year): Yes

The information below is protected under Privacy Act 1974 and will only be used to process Criminal

Background History Checks to grant or deny access to Shaw AFB. It is further understood that anyone abusing approved privileges could lose privileges and face criminal charges.

NAME SSN DOB ST-DL NO. US CITIZEN

I UNDERSTAND THAT AS SPONSOR, I AM RESPONSIBLE FOR THE PERSON(S) LISTED ON

THIS FORM AND FOR ENSURING THE ABOVE NAME INDIVIDUAL(S) TURN(S) IN PASS OR

RETRIEVE IT ONCE THE INDIVIDUAL(S) ARE TERMINATED, QUIT, OR NO LONGER

REQUIRES ACCESS. IF I AM NOT ABLE TO RETRIEVE IT, I WILL NOTIFY SECURITY

FORCES ISSUING AUTHORITY TO HAVE THE INDIVIDUAL(S) PASS DEACTIVATED.

This form must be Authenticated and received through 20sfs.backgroundchec@shaw.af.mil from the actual sponsor’s email account, with the understanding that by submitting this form sponsor agrees to all conditions implied on this form.

FA4803-19-B-0001

Attachment 5 mailto:20sfs.backgroundchec@shaw.af.mil