Shaw AFB Contractor Access Request Form.pdf

DEPARTMENT OF THE AIR FORCE

20th FIGHTER WING (ACC)

SHAW AIR FORCE BASE SOUTH CAROLINA

Victory By Valor

CUI

DATE: 18-Jun-26

MEMORANDUM FOR 20 SFS/S-5V

(email to: Ms. Jacqueline Hernandez-Sears jacqueline.hernandez-sears.1@us.af.mil, SSgt Austin Simerly austin.simerly@us.af.mil, and Mr.

Joshua Arbeiter joshua.arbeiter.2@us.af.mil 803-895-9085 or 803-895-9086 / VCC Email: udg_20sfs_vcc@us.af.mil)

FROM:

SUBJECT:

WHO:

WHAT FOR:

WHERE:

If base wide give justification:

WHEN (ACCESS DATE/DAYS/TIMES):

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.

Full Legal Name (Last, First MI)

Date Of Birth (Year/Mo/Day)

Social Security Number

(XXX-XX-XXXX)

ST-DL #

(REAL ID Y/N)

(T-0 Standard - in accordance with DoDM 5200.08V3, DAFMAN 31-

101V3), U.S.

Citizen (Y/N)

PLEASE READ THE STATEMENTS BELOW:

- 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.

- If you, as the sponsor, filled out the request and answered N for U.S Citizen please make sure you submit scanned in documents before coming to the VCC. **i.e.- FOREIGN VISA, PERMANENT RESIDENT CARD (Form I-551) & EMPLOYMENT AUTHORIZATION CARD (Form I-766) HOLDERS, ETC.

- AS THE SPONSOR, I will inform my visitors they must have identification in compliance with the Real ID Act OR have a Federal ID in which cases they do not.

If they do not, they will not be able to receive a pass from the VCC.

- THIS FORM MUST BE SENT BY THE SPONSOR LISTED ABOVE FROM THEIR GOVERNMENT EMAIL AND RECEIVED AT THE EMAIL ADDRESSES/FAX NUMBER LISTED ABOVE IN THE 20 SFS/S-5V SECTION OR THE REQUEST WILL NOT BE PROCESSED.