Attachment 14-Base Access Template (CAO Jul 24).pdf
PDF 231 KB Posted
- Attached to
- B611 HVAC Repair
- Solicitation number
- FA480326B0001
About this file
This is a Department of the Air Force access request form used by Shaw Air Force Base (20th Fighter Wing, ACC) to process Criminal Background History Checks for individuals requiring base access. The form is a template designed to collect and submit personnel information for DBIDS (Defense Biometric Identification System) pass issuance and access control purposes.
The form requires sponsoring officials to submit complete personal information for each individual requesting base access, including full legal name, date of birth, Social Security number, state driver's license number with REAL ID status, and U.S. citizenship verification. The sponsor is responsible for ensuring pass return or deactivation when individuals are terminated, quit, or no longer require access, and must submit the completed form via government email to the 20th Security Forces Squadron (20 SFS/S-5V) section. The document includes Privacy Act 1974 protections and emphasizes sponsor accountability for maintaining security of approved access privileges. Misuse of approved privileges may result in loss of access and potential criminal charges.
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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:
FROM:
SUBJECT:
WHO:
WHAT FOR:
WHERE:
If base wide give justification:
WHEN:
SPONSOR NAME:
DOD EDPI:
CONTACT INFO:
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.
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.
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)
File details come from the government source that posted it. Updated .