Attachment_6_-_SFS_FORM_30.pdf
PDF 191 KB Posted
- Attached to
- Chapel Kitchen Renovation Federal contract opportunity
- Solicitation number
- FA489719BA009
About this file
Attachment 6 - SFS FORM 30
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment_FA489719BA0090001.pdf | ||
| Amendment_FA489719BA0090002.pdf | ||
| Attachment_10_-_Utilities_Map.pdf | ||
| Attachment_9_-_Asbestos_and_Lead_Inspection.pdf | ||
| Attachment_8_-_FSRM_PCR.pdf | ||
| Amendment_FA489719BA0090002.pdf | ||
| Attachment_7_-_Questions_and_Answers.pdf | ||
| Attachment_11_-_Addendum_1.pdf | ||
| Attachment_3_-_PCR_Appendices2.pdf | ||
| Amendment_FA489719BA0090001.pdf | ||
| Attachment_1_-_Chapel_Kitchen_SOW.pdf | ||
| Attachment_2_-_Design_Drawings3.pdf | ||
| Solicitation_-_FA489719BA009.pdf | ||
| Attachment_4_-_Wage_Determinations.pdf | ||
| Attachment_5_-_Grand_View_Gate_Access_Information.pdf | ||
| Attachment_2_-_Design_Drawings2.pdf | ||
| Attachment_2_-_Design_Drawings1.pdf | ||
| Attachment_3_-_PCR_Appendices1.pdf |
Show all 18
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Text version
b
FOR OFFICIAL USE ONLY
MEMORANDUM FOR 366 FW/A7SB
FROM:
**VOID AFTER**
** 45 DAYS **
SUBJECT: Request for Installation Entry Pass (366 SFS Form 30)
1. The following individual is requesting issuance of a Base Access Pass for the reason/time period listed. This letter is submitted IAW the 366 FW/Installation Defense Instruction.
TYPE/FILL OUT LEGIBLY OR APPLICATION WILL NOT BE PROCESSED
APPLICATION MUST BE FILED TWO WEEKS IN ADVANCE OF NEEDING BASE ACCESS
1. FULL LEGAL NAME (FIRST, FULL MIDDLE NAME, LAST) 2. GENDER
M F
3. SSAN 4. DATE OF BIRTH (YYYY/MM/DD)
5. DRIVERS LICENSE NUMBER (OR PASSPORT NUMBER) 6. STATE 7. CONTRACT NUMBER
8. CONTRACT DATES / DATES OF VISIT 9. DUTY HOURS 10. DAYS REQUIRED (i.e. M/W/F)
Su M Tu W Th F Sa
11. EMPLOYED BY / SPONSORS NAME & EMAIL ADDRESS 12. SPONSOR’S PHONE #
2. Does the contractor require access to classified material: YES NO
3. Individual listed has been informed a background and local files check will be conducted. The individual has been informed that disclosure of the above information is voluntary; however, failure to do so could result in the individual being denied access to the installation.
Authenticated on by
(Date)
(Signature)
1st Ind, 366 FW/A7SB
MEMORANDUM FOR:
Approved/Disapproved
(Printed name & grade) 366 FW/A7SB
PRIVACY ACT STATEMENT: Authority: 50 U.S.C 797 and DOD Directive 5400 B
PRINCIPAL PURPOSES: To identify personnel requesting unescorted entry on to MHAFB who are Official Business Guests/
Students/Visitors/Houseguests/Designated Agents/MHSD Employees/FW-CC Sponsored Guests. ROUTINE USES: Information will be used to conduct a wants and warrants, criminal history check through the Air Force Law Enforcement Terminal System (AFLETS) and the local files check at the security police reports and analysis section (366 FW/A7SR).
DISCLOSURE IS VOLUNTARY: Failure to provide the information could result in the individual being denied base access. This letter of request will be sent to 366 FW/A7SB two weeks prior to the date the individual concerned requires the pass. 366 SFS FORM 30, Dec 2012
DISPOSITION: This document is for official use only once completed; if this document is no longer in use shred it for protection of the contents.
FOR OFFICIAL USE ONLY
I_________ A_________ S_________ L_________
| Text1: 366 FAS/PKB |
| Text2: |
| Text3: |
| Text4: |
| Text5: |
| Text6: |
| Text8: |
| Text9: |
| Text10: |
| Text11: |
| Check Box19: Off |
| Check Box20: Yes |
| Check Box21: Yes |
| Check Box22: Yes |
| Check Box23: Yes |
| Check Box24: Yes |
| Check Box25: Off |
| Text26: / Austin Breault, austin.breault@us.af.mil |
| Text27: 208-828-1950 |
| Group28: Choice2 |
| Group1: Choice1 |
| Text7: SSgt Austin Breault |
366 FAS/Contract Specialist/208-828-1950
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