Attachment 6 - Base Access Request .docx

DEPARTMENT OF THE AIR FORCE

20th FIGHTER WING (ACC)

SHAW AIR FORCE BASE SOUTH CAROLINA

DATE: 2/29/2024

FROM: Mr. Darrel Ford SUBJECT: Request for Base Access

WHO:

WHAT FOR: Paint Indefinite Delivery Indefinite Quantity Site Visit WHERE: 321 Cullen Street, 20th Contracting Squadron If base wide give justification: N/A

WHEN:

SPONSOR: Mr. Darrel Ford

CONTACT INFO: 803-895-5381

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, at a minimum, lose said privilege and possibly face criminal charges.

Full Legal Name (Last, First MI) Date Of Birth (Year/Mo/Day) Social Security Number

ST-DL #

(REAL ID Y/N)

U.S.

Citizen (Y/N)

I UNDERSTAND THAT AS THE SPONSOR I AM RESPONSIBLE FOR THE PERSON(S) LISTED ON THIS FORM, AND FOR ENSURING THE ABOVE NAME INDIVIDUAL(S) TURNS IN THE DBIDS PASS OR RETRIEVE THE PASS ONCE THE INDIVIDUAL(S) ARE TERMINATED, QUIT, OR NO LONGER REQUIRES ACCESS. IF I AM NOT ABLE TO RETRIEVE THE PASS, I WILL NOTIFY SECURITY FORCES TO HAVE THE INDIVIDUAL(S) PASS DEACTIVATED IN DBIDS.

This form must be sent by the sponsor from their government email and received at the email addresses/fax number listed above in the 20 SFS/S-5V section.

CUI

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