Visitor-Prenotification-Form.pdf
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Department of the Air Force
About this file
This is a Short Term Visitor Pass Pre-Notification Form for Kirtland Air Force Base, dated February 2017. The form is a template used to request and record the issuance of visitor passes to the installation and must be completed and submitted to either the Gibson Visitor Control Center or Truman Visitor Control Center no earlier than 72 hours prior to the visitor's arrival.
The form requires sponsor information including the sponsor's first name, last name, full Social Security number, organization, and contact phone number. The sponsor must validate their sponsorship authority, and the form must be verified as complete by VCC personnel prior to visitor arrival. Visitor information required includes the visitor's first name, middle name, last name, date of birth, driver license state, and U.S. citizenship status. The pass duration cannot exceed 30 days; if a visitor receives three or more passes totaling 30 days or more within a 90-day period, both sponsor and visitor must follow procedures to obtain a long-term pass. The form requires specification of destination(s), start date, end date, and access times. The visitor must report to the designated VCC with a valid government-issued picture identification to obtain the pass. The sponsor acknowledges responsibility for the visitor's actions and compliance with installation instructions, with failure to comply potentially resulting in loss of sponsorship privileges. The form includes a Privacy Act Statement restricting disclosure of the document's contents to individuals with a direct need-to-know in performance of official duties.
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Text version
February 2017
KIRTLAND AFB
SHORT TERM VISITOR PASS
PRE-NOTIFICATION FORM
SPONSOR INFORMATION
FIRST NAME
LAST NAME
FULL SSN
ORGANIZATION
CONTACT PHONE
This form must be completed and submitted to the Gibson Visitor Control Center (VCC) or Truman VCC no earlier than 72 hours prior to visitor arrival. Upon form submittal, VCC personnel will validate sponsorship authority and verify the form is completed correctly. The visitor must report to the designated VCC with a valid government issued picture ID card (DL, State ID, etc.) to obtain a pass. This form must be submitted prior to visitor arrival or the sponsor will be required to report to the VCC to obtain a pass for the visitor.
VISITOR INFORMATION (one visitor per form)
FIRST NAME
MIDDLE NAME
LAST NAME
DATE OF BIRTH
DRIVER LICENSE STATE
US CITIZEN YES___ NO___ (If no, list country of citizenship)___________________________
PASS INFORMATION
The duration of this pass cannot exceed 30 days. If the visitor has 3 or more passes totaling 30 days or more within a 90 day period, the sponsor and visitor will be required to follow the procedures to obtain a long term pass.
DESTINATION(S)
START DATE
END DATE
ACCESS TIMES (i.e. 0730-1630)
SPONSOR ACKNOWLEDGMENT
I understand that I am responsible for the actions of all visitors I sponsor onto the installation. I understand that failure to comply with instructions could result in my loss of sponsorship privileges. If you need more information, please contact me at the above number.
DATE SPONSOR SIGNATURE
PRIVACY ACT STATEMENT: The contents of this/these document(s) shall not be disclosed, discussed, or shared with individuals unless they have a direct need-to-know in the performance of their official duties. Deliver this/these document(s) directly to the intended recipient. DO NOT drop off with a third party. ROUTINE: To request and record the issuance of a Visitor when the use of another form is not authorized. Failure to provide any of the information requested may result in non-issuance of the Visitor Pass. This information is necessary for validation of the sponsor’s identity and determination of entry eligibility of the visitor onto Kirtland Air Force Base. Failure to provide this information may result in a non-issuance determination by the issuing authority.
| FIRST NAME: |
| LAST NAME: |
| FULL SSN: |
| ORGANIZATION: |
| CONTACT PHONE: |
| FIRST NAME_2: |
| MIDDLE NAME: |
| LAST NAME_2: |
| DATE OF BIRTH: |
| DRIVER LICENSE STATE: |
| If no list country of citizenship: |
| DESTINATIONS: |
| START DATE: |
| END DATE: |
| ACCESS TIMES ie 07301630: |
| DATE: |
| Check Box1: Off |
File details come from the government source that posted it. Updated .