Atch 11 Base Access Template-How-To Informational.pdf
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- Solicitation number
- FA4803250001
About this file
This is a base access request form template used by Shaw Air Force Base's 20th Fighter Wing (ACC) for processing criminal background checks and granting base access to contractors and employees. The form requires submission to the 20th Security Forces Squadron (20 SFS/S-5V) and must be sent by a CAC-holding sponsor from their government email.
The template requires detailed information including the purpose of access (construction, new hire, job interview, etc.), specific work location, exact dates and hours of access needed, and sponsor details. Personal information required includes full legal name, date of birth, social security number, state driver's license number (with REAL ID status), and U.S. citizenship status. The sponsor is responsible for ensuring DBIDS passes are returned or deactivated when access is no longer needed. A separate work request is required for individuals under 18 years of age. This template is an attachment to a pre-solicitation for a Family Camp Recreational Vehicle Parking Expansion project at Shaw AFB.
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Text version
DEPARTMENT OF THE AIR FORCE
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
CUI
Victory By Valor
DATE: XX/XX/XXXX
MEMORANDUM FOR 20 SFS/S-5V:
(email to: BOTH Ms. Jacqueline Hernandez-Sears jacqueline.hernandez-sears.1@us.af.mil, TSgt Shelby Pontieri shelby.pontieri@us.af.mil , OR FAX 803-895-5337……. DUTY #:803-895-9085 or 803-895-9086/ VCC Email: udg_20sfs_vcc@us.af.mil)
This form MUST be sent by the sponsor listed from their government email and received at the email addresses/fax number listed above in the 20 SFS/S-5V section.
FROM: (The person requesting background check be conducted and squadron/unit)
SUBJECT: (i.e Contractor/Employee needing access to Shaw AFB)
WHO: (Company or Organization the Contractor/Employee will be working for)
WHAT FOR: (i.e Construction, New Hire, Job Interview, Meeting, New CAC or CAC Renewal, Work order etc.)
WHERE: (Location Contractor/Employee will be working at or needing access to)
If base wide give justification: (i.e Individual needs access to multiple buildings on base)
WHEN: (The exact day/dates and hours the individual will need access to the base (i.e. May 10, 2022, 0800-1700hrs or from May 10, 2022- May 10, 2023 Monday-Saturday, 0700-1900hrs)
SPONSOR: (The CAC holding individual responsible for the individual listed below and their organization)
CONTACT INFO: (Sponsor’s GOV email and PHONE NUMBER W/EXTENSION)
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)
********IF UNDER THE AGE OF 18, PLEASE COMPLETE A SEPARATE WORK REQUEST.*********
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.
mailto:jacqueline.hernandez-sears.1@us.af.mil mailto:shelby.pontieri@us.af.mil
File details come from the government source that posted it. Updated .