Base_Access_Template.xlsx
XLSX spreadsheet 15 KB Posted
- Attached to
- Nellis AFB ADAIR II Federal contract opportunity
- Solicitation number
- FA4861-18-R-C003
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Sheet1 Sponsor Name: Completed by Contracting
| Sponsor Signature: | Completed by Contracting | |||||||||
| Phone #: | Completed by Contracting | |||||||||
| Company | Last Name | First Name | MI | Country of Citizenship | DOB | SSN | State AND DL#/ID# | Location(s) | Valid Dates(s) | Valid Day(s) & Hrs |
JUSTIFICATION:
Note 1: Specify in detail justification requesting the person(s) listed above having unescorted access. (i.e. requires access 3 times a week to service vending machines on Nellis AFB) Note 2: If you are using a Driver’s License from California, Colorado, Connecticut, District of Columbia, Illinois, Maryland, Utah, Vermont and Washington states an additional form of government issued ID is required (i.e. US Passport, original Birth Certificate with raised seal, original Social Security Card, etc. Note 3: If individuals are listing another country other than the US for residency please include a second form of identification, such as a copy of their passport/visa/work permit, resident alien card or SSN card.
I certify, in accordance with FAR 52.222-54 "Employment Eligibility Verification" that I have performed checks on all above listed employees through the E-Verify system.
Printed Name Signature
(PRIMARY CONTRACTOR NAME)
(PROJECT NAME)
The individuals listed below have been thoroughly briefed on entry procedures and conconduct while on Nellis/Creech AFB.
Sheet2
Sheet3
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