Visitor's_Pre-Announcement_Notification_TEMP_Modified_28_Jul_2014.doc.pdf

DEPARTMENT OF THE AIR FORCE

AIR FORCE RESEARCH LABORATORY

EDWARDS AIR FORCE BASE CALIFORNIA 93524

Important Note: This worksheet contains information which must be protected IAW AFI 33-332 and DOD Regulation 5400.11; Privacy Act of

1974 as amended applies, and it is FOR OFFICIAL USE ONLY (FOUO). This worksheet will be destroyed after information provided has expired.

MEMORANDUM FOR AFRL/RQOF

FROM:

SUBJECT: Visitor’s Pre-Announcement Notification

The below listed individual is employed by______________________________________ will require access to the Air Force Research Laboratory (AFRL), Edwards AFB CA for the purpose specified below:

a. NAME: _________________________ _________________________ ______

(LAST) (FIRST (NO NICKNAME)) (M.I.)

b. SSAN: _________________________ CITIZENSHIP: ___________________________________

c. DRIVERS LICENSE #/STATE: ______________________________________________________

d. PLACE OF BIRTH: ______________________: DOB: __________________________________

NATURALIZATION CERTIFICATE #: _______________________________________

NATURALIZATION CERTIFICATE DATE: ___________________________________

NATURALIZATION CERTIFICATE LOCATION: ______________________________

e. DURATION OF VISIT: Beginning: _________________ Ending: ________________________

f. AFRL POINT OF CONTACT (POC):__________________________________________________

g. SPONSOR DOD CAC ID #______________________ SPONSOR RANK:___________________

h. ORGANIZATION/OFFICE SYMBOL: _______________________________________

i. AFRL POC’s TELEPHONE NUMBER: _______________________________________

j. SPECIFIC PURPOSE OF VISIT(s): _______________________________________

k. LOCATION OF VISIT (BLDG #/AREA): ______________________________________________

l. WILL ACCESS BE REQUIRED FOR ZONE 2: YES _____ NO _____

m. RESTRICTED AREA 19: AREA 1-42: YES _____ NO _____

n. RESTRICTED AREA 20: AREA 1-120, 1-125: YES _____ NO _____

o. FOR UN-ACCOMPAINED ACCESS INTO A RESTRICTED AREA (19 or 20), THE VISITOR MUST AT

LEAST A FAVORABLE NACI.

p. CLEARANCE LEVEL: _______________ DATE OF INVESTIGATION: ___________________

SIGNATURE OF UNIT/COMPANY/FIRM SIGNATURE OF AFRL CONTACT

SPONSOR/SECURITY MANAGER/OFFICER (DoD Gov’t Civilian or Active Duty Military)

Important Note: This worksheet contains information which must be protected IAW AFI 33-332 and DOD Regulation 5400.11; Privacy Act of

1974 as amended applies, and it is FOR OFFICIAL USE ONLY (FOUO). This worksheet will be destroyed after information provided has expired.

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